Latissimus Dorsi Flap

This information sheet explains the implications of breast reconstruction surgery and should be read in addition to the Breast Cancer Care booklet ‘Breast Reconstruction’.

This information is intended to help you to understand the operation and the after care that will be necessary to achieve the best possible results.

What does this involve?

This type of operation uses the latissimus dorsi muscle- a large muscle that lies below the shoulder blade.  The skin and muscle is cut away from the back but the blood vessels of the flap remain attached to the body at the end nearest the arm pit. The flap is then rotated and tunnelled through a cut made below the armpit. In this way, it is brought round to the front of the body to lie over the chest wall and form the new breast shape. Sometimes this also involves inserting a tissue expander or implant under the muscle to increase the size of the breast. (See information leaflet on tissue expander/implant). The skin is closed using dissolvable sutures.

The operation

The operation is carried out under general anaesthetic and takes approximately three to four hours to perform.

Hospital stay and aftercare

For most patients the hospital stay is about 3-5 days, but this will depend on your recovery. An appointment will be made for you to return to the clinic to see your Consultant/Breast Care Nurse to have your wound checked. 

You may also need to attend this clinic for further dressings.  Your wounds should be kept covered by dressings until your Consultant/Breast Care Nurse is happy with your wound. The stitches will be dissolvable.

You will be offered painkillers both in hospital and to take home.

A comfortable bra can be worn after surgery.  You may need to wear a soft prosthesis or padding in a bra initially. Under wired bras should be avoided until your wounds are healed.

After three to four weeks, you may start light exercise. It is however important that you do your arm exercises as instructed by the physiotherapist.

Return to work will depend on your occupation.  Light duties can usually start within three to four weeks.

You will need to attend the outpatients department every two to three weeks initially for expansion procedures (Refer to tissue expansion leaflet).

Heavy lifting and strenuous exercise should be avoided for at least six weeks.

Driving should be avoided until your wounds have healed and you can comfortably wear a safety belt. This may take several weeks.

Any specific instructions will be explained to you before you leave hospital.

What are the risks of this procedure?

Most patients will experience few, if any, complications but it is important to be aware of any potential problems.

Bleeding

Bleedingmay occur after surgery (usually within 12 hours of the operation).  A very small amount of bleeding is not uncommon but anything more than this may mean another short operation to stop the bleeding.

Infection

You will be given antibiotics during the operation to reduce the risk of infection.  If the wound becomes infected after surgery, you may require a course of antibiotics.

Asymmetry (unequal size and shape)

In the short term there can be a difference between the breasts depending on your breast size.  After the breast reconstruction the size and shape of the new breast will adjust with time and weight changes. It may feel firmer and slightly cooler than normal breast tissue.

Some women have some degree of asymmetry (unequal size and shape) between breasts and this is more likely after this surgery.  If necessary, further surgery can be carried out by inserting a tissue expander and then an implant to achieve an acceptable size (see tissue expander/implant reconstruction leaflet). Some patients prefer not to have implants and opt for some lipo-modelling (fat transfer) to increase the breast size (see leaflet on lipo-modelling).  This may involve a further 2 operations.  Alternatively, adjustment surgery could be carried out to the opposite breast if your surgeon recommends this.

Scars

You will have 2 scars above and below your flap.  You will also have an additional scar on your back where the skin and muscle has been removed.

It is very common for women to develop a seroma or fluid collection around their back wound and this will require draining from time to time. If you develop a seroma or are concerned, then contact you breast care nurse.

All scars are red and raised initially and begin to settle over a 12-month period. 

Breast cancer and mammography

Breast reconstruction does not increase or decrease the risk of developing breast cancer or a recurrence of a previous cancer.

There is no indication following mastectomy, to perform mammograms on the reconstructed breast.  Follow up mammography should continue on the remaining breast.

If you require any further information or advice, please contact your breast care nurse.

If you have any problems out of hours or weekends then you can telephone 111 (NHS non-emergency contact number).

Further information can be obtained from:

Cancer BACUP