What is latissimus dorsi flap reconstruction?
Latissimus dorsi flap reconstruction, also known as an LD, is a breast reconstruction technique using muscle and tissue from your back around your shoulder blade.
During an LD, your doctor removes an oval section of skin along with your latissimus dorsi muscle, which is one of the largest muscles in your back. They leave the blood vessels attached to the tissues.
They then move this tissue underneath your skin to the front of your chest, where it’s placed in the breast pocket. Depending on breast volume, the procedure may be combined with placing a tissue expander or implant.
Your surgeon may perform an LD right after your mastectomy or schedule the procedure for a later date.
Keep reading to learn more about eligibility, cost, recovery, and more.
Who can have a latissimus dorsi flap reconstruction
An LD can look very natural.
This may be a good reconstruction option for women who:
- have small- to medium-sized breasts
- have extra mid-back tissue
- have had previous radiation and are having implant reconstruction
- have thin skin that needs extra coverage for an implant
- want a more natural-looking breast
- are having partial breast reconstruction
In an LD, the donor muscle is closer to your chest than pieces used for abdominal tissue flaps. An LD may also be a good reconstruction surgery if you aren’t a good candidate for an abdominal tissue flap procedure, such as:
- transverse rectus abdominis (TRAM) flap
- deep inferior epigastric perforators (DIEP) flap
- superficial inferior epigastric artery (SIEA) flap
You may not be a good candidate for an LD if you:
- don’t want scars in areas other than on your breasts
- had a chest-wall surgery before
- are a professional mountain climber, skier, or swimmer
How much it costs
With private insurance, an LD can cost around $30,783. Your insurance company may cover all or part of the cost.
If you anticipate out-of-pocket costs, patient assistance programs may help alleviate some of the expense. For example, women can apply for a grant from the Alliance in Reconstructive Surgery to help cover the medical expense of an LD or other reconstructive procedure after a mastectomy.
Breast cancer advocacy group My Hope Chest also provides financial support for women who need help covering a breast reconstruction surgery.
You may also be eligible for financial help through federal, state, or local programs. You can figure out your options by talking to a financial counselor at your hospital or clinic.
What to expect after surgery
An LD typically lasts about three to four hours. You could expect to stay in the hospital for about four days after the surgery is over. You may get medication for any pain or nausea from the anesthesia. You’ll have drainage tubes in your chest and back. You’ll need to measure and record the drainage output. These tubes will be in place about one-to-two weeks.
Recovery from the procedure can take about four weeks. You’ll need to take care of the incisions at your breast and your back, the latter of which you may need help for. You should also consider short-term physical therapy to strengthen and maintain range of motion in your shoulder.
Although you’re not on bedrest during your four weeks of recovery, you’re limited as to what you can do. When recovering from an LD, you should avoid:
- heavy lifting
- playing sports
- having sex
You may feel worse during the recovery process than you would after a mastectomy. This is because with an LD, you have surgery at two places on your body: your back and your breast. It’s important to follow your doctor’s advice and take the time to heal.
Side effects of surgery
You may feel some side effects after an LD. Those include:
Partial loss of strength or function: Your back, shoulder, or arm may feel weak because some of the muscle in your back had been taken out. During recovery, you may find it hard to pick up things and twist from side to side. An LD may also make it hard to swim, play golf or tennis, or turn objects.
Breast changes: If you needed an implant with an LD, the implant may feel more solid than the tissue before it. The piece of muscle your doctors used to reconstruct your breast may also feel tighter than your other breast. This is because the latissimus dorsi muscle is a naturally stiffer muscle.
Breast lumps: Some of the fat in your reconstructed breast may turn into firm scar tissue if its blood supply is cut off. Doctors call this fat necrosis. These lumps may go away on their own, but sometimes they don’t. You may feel some discomfort because of the lumps.
Dead tissue: In rare cases, the part of the tissue used to shape your breast may break down because it didn’t get enough circulation (necrosis). Your skin may turn dark blue or black, feel cool or cold to the touch, and possible develop open wounds. You may also feel sick or run a fever if you don’t treat the symptoms right away.
Although most of these side effects will pass as you recover, there are things that can be done to treat them:
For loss of strength or function: If you feel that your muscles are weak, talk to your doctor about options for physical therapy. They could also give you examples of exercises that can help build strength in the area touched by the surgery.
For breast lumps: Having lumps in your reconstructed breast may feel scary after you’ve had a mastectomy and reconstruction surgery. Your doctor can remove the scar tissue lumps, which may ease your mind and any discomfort you feel.
For necrosis: Your doctor can remove dead tissue if it’s in a small area. If most of the latissimus dorsi tissue used has broken down, it’s considered a “complete flap failure.” This means your doctor would have to take out and replace the entire flap.
In most cases, your doctor will remove the dead tissue and allow your body to heal before they find new tissue to use for a new flap. In some cases, your doctor may replace the dead tissue all at once.
Discussing your options with your doctor
Talk with your doctor about what reconstruction option is best for you. There are a number of factors to consider, including your eligibility, recovery time, and cost. You should also think about what you want your breast to look like and whether you want muscle removed from your back.
Reconstruction isn’t just a medical decision — it’s an emotional one too. Talk with your doctor about any concerns you may have, as well as your short- and long-term goals. Together, you can develop the best treatment plan for your condition and overall well-being.