Lat Dorsi Flap

What's involved in the Lat Dorsi Flap procedure?

Your latissimus dorsi (LD) is a muscle located on your back, just below your shoulder. You can find it on the back wall of your armpit. This muscle has been used by plastic surgeons for many years to reconstruct patients after cancer removal or after serious injury. In breast reconstruction, this muscle is taken with an overlying oval of skin and fat to recreate a breast shape. The muscle is transferred to your breast by tunnelling the tissue under your armpit skin. The blood vessels that feed the muscle (artery and vein) are left attached to their original blood supply on your back, avoiding the complexity and risks of microsurgery. This type of breast reconstruction is possible if you had radiotherapy to your chest as part of your breast cancer treatment.

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Because your back is normally quite slim, there is only a small amount of skin and fat available to transfer to your breast. This flap is therefore only useful by itself if you have a small breast. In cases where the latissimus dorsi muscle and skin transfer does not match your other breast, a breast implant is also placed under the muscle to achieve the desired shape, size, and projection. In some cases, a tissue expander implant is used, a balloon implant that can be increased in size gradually by injecting salt water. Similar to tissue expander reconstruction alone, inflation of the expander usually begins 3 weeks after your surgery and ends when the desired volume is reached. At a second stage, much smaller procedure is performed to exchange the tissue expander for a permanent silicone implant.

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The latissimus dorsi flap technique involves standard surgery and takes about 2-4 hours to perform with a 1-2 day stay in hospital. After surgery, you will have incisions on your breast and one on your upper back, normally within your bra strap line. The breast incision will contain a patch of visible skin transferred from the back. You will normally be sent home with a drain in your back for 1 week and small dressings on each of your incision sites.