Breast reconstruction using tissue from your back (Latissimus dorsi flap) - after risk-reducing mastectomy
Reconstruction using tissue from your back
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This operation uses a muscle called the latissimus dorsi and some overlying fat and skin from your back, and is often referred to as the latissimus dorsi flap (LD flap).
The flap and its blood supply are tunnelled under the skin below your armpit and put into position on your chest to make a new breast shape.
Often, there isn’t enough tissue to form the new breast shapes with LD flaps, so an implant may be put behind each flap. Occasionally, a large amount of fat is taken with the muscle. This is called an extended latissimus dorsi flap and may be done so that implants aren’t needed.
A latissimus dorsi flap may be suitable for women who have small, medium or large breasts.
It may not be suitable for women who:
want very large breasts
are very overweight
are in certain professions that involve physical activity such as lifting.
Skin-sparing bilateral prophylactic mastectomies using a latissimus dorsi flap and nipple reconstruction (with tattooing)
Front and back view two months after skin-sparing prophylactic mastectomies using a latissimus dorsi flap (without nipple reconstruction)
Benefits and limitations of reconstruction using tissue from your back
It can be used to create most breast sizes well.
The breasts look and feel more natural than with implants only.
It has a high success rate and problems with the flap are rare.
This operation takes one surgeon up to 5–6 hours to reconstruct both breasts. It may be carried out in a specialist unit by two surgeons, in which case it only takes 3–5 hours. Recovery time can be up to three months.
You will have two scars on your back. The scars are usually horizontal across the parts of your back where the muscles are taken from (see pictures above). They won’t be seen under a bra. Sometimes the scars are at more of an angle (diagonal) and more difficult to cover with a bra, but they can be covered with a swimsuit. How the scars look on the breasts will depend on the type of breast surgery you have and whether you have implants. If you have skin-sparing surgery, each reconstructed breast may have a small round scar in the area where the nipples were. If you then have your nipples and the areas around them (the areola) reconstructed this will cover the round scars. Before your surgery it’s important that you discuss with your surgeon where your scars will be and how they will look so you know what to expect after surgery.
The skin on your back is a slightly different texture and colour from the skin on your chest, so the colour of the reconstructed breasts may not completely match the colour of the skin on your chest.
There may be a small bulge under each armpit where the muscle is tunnelled under the skin. Your surgeon may be able to carry out a small procedure to reduce this.
The breasts will have little or no sensation (they will feel numb).
If you are having larger breasts reconstructed, you may need an implant as well.
Fluid under the back wound (seroma)
This is the most common problem soon after LD flap surgery. Seromas usually get better with time as your body heals, although they may need to be drained a few times. Occasionally seromas persist (chronic seroma) and need extra treatment.
After the operation you will have some weakness in your back and shoulders. This will improve over time as there are many muscles in the back that can compensate for the loss of the LD muscle.
You should regain full shoulder strength for most activities 6–12 months after the surgery. But you may notice weakness during some movements, such as pushing up to get out of the bath.
Most women can return to daily activities, including sports such as swimming and tennis, without any problems. However, the ability to take part in sports such as rowing, rock climbing, cross-country skiing or playing competitive racquet sports at a high level are likely to be affected by LD flap surgery.