What is a breast reconstruction with latissimus dorsi flap?

A breast reconstruction is an operation to recreate a breast shape after you have had a mastectomy, using the latissimus dorsi muscle from the side of your back, usually with an implant (see figure 1).

What are the benefits of surgery?

You should get a breast shape again. Using tissue from your body will help give your reconstructed breast a more natural shape and feel.

Are there any alternatives to a breast reconstruction with latissimus dorsi flap?

Using padded bras or bra inserts can give the appearance of a breast shape when you are wearing clothes.

It may be possible to have a reconstruction using only an implant.

It may also be possible to use tissue from another area of your body. You will not usually need an implant for this type of reconstruction.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes four to six hours. Your surgeon will make an elliptical (oval) cut on your back, usually along the natural creases of your skin, and a cut on your breast or in the front of your chest. They will move the latissimus dorsi muscle around to the front of your chest and use it to create a breast shape. If you need an implant, your surgeon will create a pocket under the muscle to place the implant in.

What kind of breast implant should I choose?

All implants are made of an outer layer (shell) of silicone. They can be filled with silicone or saline (salt water). The silicone used to fill the implant can be in the form of a liquid or gel (cohesive silicone). Liquid silicone and saline implants give a softer and more natural feel. Cohesive silicone implants give a firmer feel and come in more shapes, so they are often recommended to women who are having a breast reconstruction.

If you do not have enough skin or you have already had a mastectomy, your surgeon may need to use an expandable implant.

Is silicone safe?

Many studies have been carried out to find if silicone breast implants are safe. There is no evidence to suggest that women with silicone breast implants have a higher risk of developing autoimmune diseases, such as breast cancer and arthritis. There is a reported link between having an implant and a rare type of cancer called anaplastic large-cell lymphoma but the increase in risk is small.

What complications can happen?

1 General complications

  • Pain
  • Bleeding
  • Unsightly scarring
  • Blood clots
  • Infection of the surgical site (wound)

2 Specific complications

  1. Breast reconstruction complications
  • Developing a lump under your wound
  • Loss of the flap
  • Skin necrosis
  • Unnatural movement or twitching of the reconstructed breast
  • Difference in shape and appearance
  • Numbness or continued pain around your armpit or the inner part of your arm
  • Permanent numbness around the scar in the back and on most of the surface of the reconstructed breast
  • Stiff shoulder
  • Arm weakness
  1. Implant complications
  • Developing a collection of fluid in the pocket where the implant is
  • Infection of the implant
  • Thickening and tightening of the scar tissue
  • Kinking and rippling
  • Rupture or deflation of the implant
  • Rotation of the implant

How soon will I recover?

You should be able to go home after two to five days and return to normal activities after four to six weeks.

Wearing a soft, well-fitted bra will help to relieve any discomfort. If you have a reconstruction with a latissimus dorsi flap on both sides, you may find it more difficult to lift or pull yourself up.

If your surgeon needed to use an expandable implant, you will need to come back to the clinic regularly.

The shape of your reconstructed breast takes several weeks to settle. It can take up to a year for you to feel as if your reconstructed breast is part of you.

Summary

A breast reconstruction with latissimus dorsi flap is an operation to recreate a breast shape. You should consider the options carefully and have realistic expectations about the results.

Acknowledgements

Author: Mr Eoin O'Broin MD FRCS (Plast.), Mr Paul Roblin MSc FRCS (Plast.) and Miss Kalliope Valassiadou MD, Consultant Breast and General Surgeon

Illustrations: Medical Illustration Copyright © Nucleus Medical Art. All rights reserved. www.nucleusinc.com


This document is intended for information purposes only and should not replace advice that your relevant health professional would give you.

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