Latissimus Flap Breast Reconstruction St. Louis

The latissimus muscle flap is a versatile procedure that has been used for decades. The latissimus muscle is a muscle in the back that can be used for reconstruction without disabling a patient. The muscle may be used by itself or in conjunction with an implant to reconstruct a breast.

Women who have depressions or contour irregularities after lumpectomy or are having a mastectomy may benefit from this procedure. The muscle can be used to reconstruct an entire breast in the situation where a woman does not desire a prosthetic implant to be placed or to match a natural breast. The latissimus is also commonly used in situations where a breast has been radiated to reverse the radiation damage.

Candidates

Healthy women with lumpectomy deformities, women who desire a natural reconstruction or women who have had or will be having radiation to their breast are good candidates for the procedure.

Poor candidates for this surgery are women who have had already had a mastectomy some time ago. In these cases, an expander is often needed to stretch the skin in order to achieve a projecting breast. If you have had a mastectomy and radiation, you may need a latissimus flap with tissue expander – implant placed.

Preparing for Surgery

Dr. Cabbabe will ask that you refrain from taking any aspirin, plavix, Coumadin, ibuprofen or any other type of blood thinner. If you are taking chemotherapy, this will need to be finished prior to surgery.

Surgery

During the procedure, the latissimus muscle is freed up, pivoted and transferred from the back onto the chest under the skin. A horizontal scar in the bra line will be concealed by a bra. In the case of a lumpectomy, the muscle will fill the space where the breast tissue has been removed, producing a soft, full breast. In the case of a mastectomy, the muscle with a skin paddle from the back is transferred to the breast to fill the defect from the excision of the mass. The skin from the back replaces any skin removed on the breast, including the nipple – areola. If a skin sparing mastectomy has been done and a larger breast is desired, an implant or tissue expander can be placed underneath the muscle at the time of mastectomy.

A breast lift or breast reduction may be needed on the other breast in order to improve symmetry. A new nipple can be made from the back skin and areolar tattooing can be done if desired in the case of mastectomy.

Recovery

Patients are admitted to the hospital overnight. Pain medication and antibiotics will be prescribed. There may be some numbness on the breast and back which improve with time. Most patients are able to shower within 24 hours. A drain will be placed inside the breast and one or two in the back and removed in the office. These will stay in place for 1-3 weeks. Recovery is 3 to 4 weeks approximately.

Complications

The most common complication is a fluid collection which can form in the back where the muscle was removed after the drains have been removed. This occurs in up to 33% of patients and require a simple aspiration of the fluid with a syringe and needle in the office. The blood vessels to the muscle flap can be injured as a result of the procedure or the previous lymph node surgery and the muscle flap could lose blood flow, turn black and require further surgery to remove. Patients can have some shoulder weakness for the first few months but this gradually improves.

Types of Reconstruction: