Breast Reconstruction with LD flap

The operation in short

Muscle and skin from the area of the back can be used in breast reconstruction. This flap is often preferred when the breast is to be treated using radiation, as it provides better aesthetic results than reconstructive surgery with silicone implants. The flap can be of different sizes:

Latissimus dorsi (classic)

This is the most common method for breast reconstruction. Muscle and skin overlying the latissimus dorsi are taken from the back area and used for reconstruction, and then a silicone implant is added under the muscle in the area of ​​the new breast in order to give more volume.

Advantages

• This method has excellent results in terms of shape (better and more natural-looking results compared to reconstruction using only silicone implant) and can be used in both primary and delayed breast reconstruction. Thanks to the flap, the new breast (whether it has a silicone implant or not) can tolerate radiation very well without complications, as it is a very well-blooded tissue. It is a reliable surgical method with a failure rate of only 1%.

Disadvantages

• The operation is considered technically difficult and requires a stay at the hospital for up to a week, while recovery can take up to two months. Although unusual, some patients, after of surgery may feel weak and constrained in
• shoulder mobility. There is also a 2% chance of infection of the implant. There is a possibility of fluid collection in the area from which the implant has been taken which should be treated. Finally there are some risks associated with silicone implants if used. For more information, see the section on Insert Problems.

Extended latissimus dorsi flap

The use of an implant is avoided, as the muscle removed from the area of the back (along with the skin) contains enough fat, which is then used to give the desired volume to the breast.

Advantages

This operation can bring excellent aesthetic results (better and more natural-looking than that of a breast reconstruction surgery using silicone implants) and can be used in both primary and delayed reconstruction. Also, with this method, radiation can be performed easily and it is a very reliable operation with a 1% failure probability. In case of postoperative infection, it can be very easily treated as there is no silicone implant, which if infected should be removed.

Disadvantages

Not all patients are suitable candidates for this particular method. This is a technically difficult surgery that requires the patient to stay in the hospital for up to a week and then a recovery time of up to two months. Also, although unusual, some patients may feel weak and restricted in shoulder mobility after surgery. One side of ​​the spine may show a dip in comparison to the other side, as this is the exact spot from where the implant is removed. It is difficult to estimate the size of the regenerated breast, as about 30% of the volume is shed during the 12 months.

Mini latissimus dorsi flap

This method is used if only part of the breast has been removed (as in breast-conserving surgeries) and therefore only a small amount of muscle tissue (usually not including skin) needs to be moved to the operated breast to fill the gap that was created. This operation cannot be used in cases of complete mastectomy.

Advantages

• The aesthetic effect of this method is excellent (a lot better and more natural-looking in comparison to reconstruction surgery with the addition of a silicone insert) and can be performed both in immediate and the delayed reconstruction. It is considered a highly reliable surgery and since the largest part of the breast remains intact, the sensation is preserved.

Disadvantages

• It is important for the patient to consider that if in the future they have to undergo a complete mastectomy, then they will have sacrificed an important method of reconstructing the breast (muscle and skin from the back). Radiation therapy is also necessary (as in the majority of Breast reconstruction surgeries). Although the area of the back may show some problems with regard to healing and to its appearance (after surgery an impression may remain on the skin) in the long run, these are corrected.

Recovery from Surgery and Final Outcome

Duration of hospitalization

The patient is usually required to stay in the hospital for 6 days.

Duration

Depending on the type of operation, the duration may vary from 3 to 4 hours.

Mobilization

Patients will need to stay in bed for two days, during which a bladder catheter will be required.

After four days they will be able to move, while after ten to fourteen days they will be able to walk without feeling any discomfort.

After four weeks, patients will be able to exercise, while after three to four months they will have fully recovered and will be able to return to work.

Bandages

The chest and back area will be covered with gauzes for 1 week and then patients will switch to an elastic pressure corset/bra for 4 weeks.

Complications

There is also a 5% chance of developing postoperative problems in the back area, such as stiffness in the shoulder area, fluid retention, and possible inflammation.

In addition, there is a 2% chance of developing problems in the area of ​​the reconstructed breast, such as an infection around the implant, as well as partial or complete failure of the surgery.

Finally, there is a low risk of long-term postoperative problems, such as hardening of the implant, and breast asymmetry.

Please do not hesitate to contact us if you have any further questions.