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Latissimus Dorsi Reconstruction

A latissimus dorsi flap involves taking the skin, fat, and the latissimus dorsi muscle from your back, in the area below your scapula (shoulder blade) and tunneling it through the axilla (armpit) to create a breast. Sometimes it is possible to use this flap without implants in order to achieve the desired size. However, this technique often is used in conjunction with a tissue expander or implant to reconstruct the breast.

Why use a latissimus flap if you are going to use an implant anyway? There are several reasons. Using a latissimus flap with an implant typically has a more natural shape and feel than an implant alone. One way to describe this effect is for you to imagine putting an implant under a bed sheet. With only a thin sheet over the implant, all of the contours of the implant are visible and the implant can be readily felt. On the other hand, if the implant is placed under a thick comforter, the implant is there only to provide volume, and is not as visible or palpable. The former analogy describes an implant-only based reconstruction, while the latter analogy describes the latissimus flap with implant reconstruction. In addition, placing the skin, fat, and muscle over an implant may reduce complications relating to infection and radiation therapy.

Therefore, the advantages of the latissimus flap are that it decreases some of the risks of using an implant, it typically is easier to match the opposite breast with this approach, and it replaces deficient skin and soft tissue which may be missing or damaged after the mastectomy and/or radiation treatments. In cases of immediate breast reconstruction, the patient emerges from the mastectomy and reconstructive surgery almost completely restored to a natural (or sometimes better) size and shape as compared to having a mound of tissue present if an expander is utilized. After the initial surgery, there often is no additional expansion necessary. Therefore the recovery period is usually surprisingly easier than for an expander/implant reconstruction, because there is no need for the sometimes-painful injections and stretching associated with the expansion process. We utilize this technique in all age groups (young and old) with tremendous success. We believe it is optimal for women looking for a relatively quick recovery and very satisfactory results without the disadvantages of prolonged expansion and problems of implant exposure.

The disadvantages of this approach are that it requires a longer surgery, and it results in an additional scar on your back where the flap is obtained (although this scar is usually well hidden by your bra). The loss of muscle function is usually well compensated by the other muscles of the shoulder and back.