Patients who have had a mastectomy for breast cancer followed by radiation treatment to the chest may develop chest skin around the scar that is firmly attached to the underlying rib cage. If this develops, the non-elastic radiated skin is not able to be expanded by a tissue expander alone. Trying to expand and place a breast implant may lead to complications or at best, a poor aesthetic appearance to your breast reconstruction. In the setting of radiated chest skin, it is preferable to import non-radiated healthy tissue to the chest. The choices for the source of this tissue include a TRAM flap or a Latissimus dorsi flap.
The Latissimus dorsi flap is used in conjunction with a tissue expander to provide a more natural appearing breast mound contour than a breast implant alone can provide. This method of breast reconstruction involves the transfer of the back tissues (latissimus muscle, fat and small amount of back skin) to your chest mastectomy site and the placement of a tissue expander under the transferred tissue. The breast reconstruction operation lasts about 2-3 hours with one night hospital stay, or can be done as an outpatient surgery for selected patients. The transfer of the tissue does leave a scar on your back, usually around 5-7 inches long. After a few months, the tissue expander is replaced with a saline or silicone breast implant. The end result is a natural appearing breast reconstruction (please see our Photo Gallery for patient pictures).
The latissimus flap can also be used for patients that have had a large lumpectomy defect. The breast contour deformity in more severe cases can result in an unwanted appearance. The latissimus flap can be used often without any implant or expander to correct the lumpectomy defect and reestablish symmetry and form.
A small ellipse of skin from the back is taken with the muscle and the latissimus muscle with the back skin is tunneled under the armpit and positioned on the chest. A tissue expander is also placed under the flap. There is no microsurgery involved with this type of flap. The back scar is around 5 -7 inches long, depending on your anatomy.
Latissimus dorsi is a muscle on your back that helps with your arm’s downward and inward motion, useful in competitive swimming or cross-country skiing. Use of this muscle in breast reconstruction will leave your arm only slightly weaker for upto 6 months. There are other muscles that can help compensate for this loss. Almost all patients can eventually return to the same activities they were able to perform prior to this operation, including swimming and cross-country skiing.
Advantages of the Latissimus Flap for Breast Reconstruction
– Improved contour and aesthetic outcome over implant alone for breast reconstruction. Can hide the rippling and feel of saline or silicone breast implants in patients with very thin skin.
– The latissimus dorsi flap can be used in patients that received breast radiation. The non-radiated back skin and muscle provide healthy soft tissues to replace the hard and scarred chest wall skin.
– There is less likelihood that capsular contracture will develop.
Disadvantages of the latissimus flap for breast reconstruction
– Requires an Implant. The tissue from the back is not sufficient to recreate the breast mound. Most patients require an implant to help provide the needed breast projection. Some of the complications associated with implants, including infection and leakage also apply.
– Most patients require a 1 night stay in the hospital and 2-3 weeks prior to returning to work. Some patients may be good candidates to do this surgery as outpatient surgery. Heavy lifting is not possible for up to 6 weeks.
– Patients with lymphedema may experience transient worsening in arm swelling. Use of a compressive sleeve maybe required.
Visit our Seattle office for a consultation
Please come in for a consultation to see additional patient photos. Also, we have many patients that have had a Latissimus flap breast reconstruction by Dr. Isik who live in Seattle, Eastern Washington, Oregon, Montana and Alaska, that would be happy to share their experience and answer your personal questions. We also have a breast cancer and reconstruction support group that meets once a month in Seattle at The Polyclinic. This is an opportunity to meet and often, see other patients that have had a TRAM, Latissimus, or Implant method of breast reconstruction. Please contact us or download our breast reconstruction brochure to find out more.