Breast reconstruction by latissimus dorsi flap with or without implant

This type of reconstruction implies skin and muscle extraction from the side of the thorax and the back. An additional scar is created in this area. Breast reconstruction by latissimus dorsi flap is advised when the quality if the skin on the thorax make it impossible to use an isolated implant and when thorax morphology and the size and shape of the contralateral breast makes it possible. Morphology of the thorax and the contralateral breast rarely allow the absence of implant and the use of the isolated flap. In most cases, the volume of the breast is reconstructed with an implant associated with a latissimus dorsi flap.

Before the procedure

It is recommended to stop smoking one month before and one month after the surgery (smoking can delay healing).
No aspirin-based medication should be taken during the 10 days preceding the operation.

The procedure

The procedure is performed under general anaesthesia and lasts between 3 and 5 hours.
A skin paddle from the thorax and back and the latissimus dorsi is extracted through a horizontal or oblique incision on the side of the mastectomy. The flap is rotated from the lateral and dorsal area to the anterior thoracic area. The mastectomy scar is opened and the flap is placed. The area of extraction is sutured. Drains suck up post-operation secretions and reduce the risk for bruising.

After the procedure

Pain varies from one patient to another. It is systematically preventively treated and adapted to your case. Flap vitality (colour, temperature, capillary pulse) is regularly monitored. Every surgery can imply risks and complications. A new bandage is placed on the 2nd day after surgery. Drains are removed between the 2nd and the 10th day.

Result

The reconstructed breast is soft and more or less voluminous. Over time, it will follow the natural evolution of the contralateral breast. A second and even a third operation may be necessary with a few months between each for a better symmetry of the contralateral breast and to reconstruct the areola and the nipple. Unilateral extraction of the latissimus dorsi does not result in a major functional discomfort in daily life. A temporary limitation of shoulder mobility can require physical therapy sessions. Physical therapy sessions are systematically prescribed.