Description The Latissimus Dorsi Flap operation uses skin and muscle from the upper outer back to replace the missing breast skin and a portion of the breast mass. The flap is kept alive by blood flow through the muscle. An implant is usually (but not always) placed under the flap in order to reconstruct the appropriate breast volume. The implant can be of either the silicone gel or saline type.
Necrosis of flap: The Latissimus Dorsi Flap has an extremely good survival record because of excellent circulation through the muscle. Prior surgery that has damaged the blood supply or severe atherosclerosis (generalized narrowing of arteries) can inhibit blood flow to the latissimus dorsi muscle and cause partial or complete potential flap loss in rare instances.
Minor necrosis: If the tip or end of the flap necroses, there will usually be enough healthy tissue remaining to obtain a good result. A second surgery will be required to remove the dead tissue and perhaps a third procedure to readjust or reposition the remaining tissue. The occurrence rate of this problem is in the 2-3% range or less.
Major necrosis: If all or most of the flap dies because of poor blood supply, the necrotic tissue will need to be removed and the reconstruction completed with an alternate method (TRAM flap from the abdomen, etc.). The occurrence rate of this problem is in the 1% or less range.
Numbness: Following surgery the reconstructed breast mound has no sensation in the area where skin from the back has been transferred. Partial sensation may develop with time.
Areas of hardness: Occasionally, some of the transferred tissue becomes partially necrotic even though the skin, muscle and most of the fat survives normally. If this occurs, there may be areas of hardness where the areas of necrosis become “calcified.”
Nipple: If nipple reconstruction is desired a secondary procedure can be performed later.
Need or later surgery & surgeries: The goal of the 1st operation is to transfer the necessary tissue to the breast area. The best possible effort will be made to complete the reconstruction in one stage. Second and even third or more procedures are sometimes necessary to achieve the best possible result.
Asymmetry: The best possible reconstruction may not make the new breast look like the other side. A surgical procedure on the opposite breast is frequently indicated to equalize size or reduce sagging.
Scar on back: The donor site scar will be permanently visible and will probably widen over time due to tension. The side of the back from which the skin and muscle has been transferred may feel tighter on a short and possibly long term basis.
Back asymmetry: Because the latissimus dorsi muscle helps form the contour of the upper outer back region, the operated side will have a different appearance than the normal side.
Muscle weakness: There is usually no appreciable loss of latissimus dorsi function. In very rare cases, loss could occur and provide a minimal level of disability.
Fluid accumulation: A common minor complication is the persistence of fluid (seroma) in the area of the back where the muscle came from. This may require one or multiple needle aspirations to correct the problem.
Contour Affiliates Recovery Garments: Compression garments or post-surgical garments help improve and increase blood circulation, rid your body of potentially harmful fluids, decrease your post surgery recovery time and reduce swelling. Visit Dr. Zienowicz’s online store to browse compression products designed to aid your recovery.