Latissimus Dorsi (LD) Flap

This operation takes skin, fat and muscle from the back. It is a commonly performed operation and can be done in combination with an implant or without. It is a very good technique in immediate breast reconstruction, but can also be used in delayed reconstruction. When feasible, extra skin and fat is removed to give additional volume, so avoiding the need for an implant. This is called an extended LD flap. The extended LD flap leaves a longer scar on the back and has slightly higher wound healing risks. However, it does allow the advantages of using the patients own tissue, with more natural feel and better symmetry over time.

Operation in brief

Latissimus Dorsi Flap

The muscle is dissected free with a patch of skin. The size and position of this skin will vary depending upon reconstructive needs. The muscle and skin patch are tunnelled through the armpit area into the breast. The hole in the back is closed leaving a scar. The skin and muscle are then shaped into the required shape. An implant is added behind the muscle if needed for volume. In immediate reconstruction only a small area of skin (usually the nipple area) is replaced compared to secondary reconstruction when a larger patch of skin is needed.

Latissimus Dorsi Flap facts

Scars

The scar on the back will vary from 15-35cms in length. It can sometimes be hidden within the bra strap area. Scars tend to be pink in the first 3-6 months and then fade to white.

Length of surgery and hospital stay

Surgery takes approximately 3-4 hours with a 3-4 night stay.

Time off work and recovery

Allow 8-10 weeks. People vary in recovery. Patients are mobile after 2-3 days. There is usually discomfort for 2-3 weeks. Moderate exercise is feasible at 4-6 weeks and strenuous exercise (aerobics) at 12-14 weeks. Driving is usually possible after 4-5 weeks. There will be some stiffness and weakness in the shoulder for 6 months returning to normal after 1 year.

Potential complications and limitations

This is a large but routine operation being a success for the majority of patients. However, it is very important you understand that operations can have complications such as bleeding, infection, wound problems or variable scar quality. With LD flap breast reconstruction additional potential problems include fluid collection in the back needing drainage, weakness or stiffness of the shoulder, possible hardening around the implant if used, infection around the implant or flap failure causing loss of reconstruction in 1-2% cases.