Latissimus Dorsi breast reconstruction (LD)
Latissimus dorsi (LD) flap breast reconstruction uses muscle, fat and skin from your back to create your new breast. The volume can be enhanced using fat grafting (lipofilling) or a breast implant.
What does it involve?
An oval-shaped piece of skin attached to the underlying muscle (LD), along with fat around the skin is freed from all of its connections to your body apart from an area in the armpit. This tissue is then tunnelled under the skin of the armpit to be brought out at your mastectomy site. This flap of tissue is then used to create your new breast.
What are the benefits?
This method of breast reconstruction is reliable and offers a shorter recovery period than other more complex techniques. It may be used if you have had previous radiotherapy to your mastectomy site.
How long does the surgery take?
The surgery takes up to 4-hours. You will be carefully monitored during and after the procedure, needing a catheter (a tube that goes into your bladder to collect urine), a variety of drips and surgical drains – all of which come out during the first few days in hospital.
What is the recovery period?
You will stay in hospital for about 3-days, but it will probably take you about 2- months until you have recovered completely. It is normal to produce a lot of fluid into the drain coming from the back wound after this operation. It is therefore normal practice to be discharged from hospital with the drain still in, with plans made to remove it around 10-days after surgery.
How long before daily activities may be resumed?
You will be able to resume all regular activities by 6-weeks. You should be able to drive by 4-weeks.
What are the success rates?
The overall success rate of the LD flap procedures is over 99%. Problems that result in failure may be due to blood supply impairment to the flap of tissue, which may arise due to previous surgery or radiotherapy to the armpit; although these problems are uncommon. Occasionally, a small part of the skin that was taken from the back does not survive, and becomes a scab which usually allows healing to take place underneath it. It is not uncommon to have some shoulder stiffness after this operation, so physiotherapy exercises are important to perform regularly.
What are the possible complications?
Other complications include general complications from surgery: wound infection or breakdown (both back and breast – if significant in the breast this may require a further operation); seroma (accumulation of fluid, usually in the back); bleeding (requiring transfusion or occasionally return to surgery); fat necrosis (areas of the fat of the reconstruction not surviving due to an inadequate blood supply, requiring dressings or occasionally a return to the operating theatre); lumpy scarring in some people; blood clots in the legs (DVTs) that may go to the lungs (PEs) and chest infections (as a result of the long anaesthetic).