Latissimus Dorsi Flap
The latissimus dorsi flap utilizes skin, fat and the latissimus dorsi muscle from the back.
In most patients there is insufficient tissue to reconstruct an entire breast and therefore an implant may also be used in conjunction with this flap.
An elliptical portion of skin is removed from the back so that the scar is in line with the bra strap.
The tissue that has been transferred to the breast can then be used to reconstruct the breast itself, or replace damaged or radiated skin on the chest
During the procedure, an elliptical portion of skin and fat attached to the latissimus muscle are dissected away from all other tissue.
A tunnel is then made between the back and the breast underneath the axilla. The flap is then tunneled into the breast pocket.
The flap remains attached to the body during the entire operation.
The skin on the back is then sewn together, leaving a scar in the bra-line. The skin from the back is sewn to the breast skin. The latissimus muscle is used to create a new pocket to cover the implant
After the surgery there will be an elliptical patch of skin (from the back) on the reconstructed breast.
2. Preoperative Considerations
The typical candidate for the latissimus dorsi flap surgery is a woman with a history of radiation to the chest and insufficient abdominal tissue for the DIEP flap. Most women also require implants (a tissue expander and a permanent implant)
Patients that are not candidates for this type of surgery include:
Patients that smoke
Patients that are professional athletes
Patients with a BMI > 32. Click here to calculate your BMI.
The surgery is 4 hours long. Patients stay in hospital for 2 days. Drains are required in the breast as well as the back and these are usually removed on post-operative day 10.
The surgery is 8 hours long. Patients stay in hospital for 3-4 days. Drains are required in the breasts as well as the back and these are usually removed on post-operative day 10.
3. Surgical Considerations
Following surgery patients are restricted from exercise or heavy activity for a period of 4 weeks. Patients typically return to work after 2-3 weeks. Nipple reconstruction is performed 3 months following flap surgery. Many patients work with a physiotherapist in order to optimize shoulder flexibility after this surgery.
4. Postoperative Considerations
Capsular contracture (up to 30%)
Wound healing complications (15%)
Mastectomy flap necrosis (15%)
Seroma of the breast or back (15%)
Persistent shoulder stiffness (5%)
DVT: 0.07 - 3.5%
PE: 0.09 - 2%
Total flap failure (rare)