Breast Reconstruction Surgery: The Latissmus Dorsi Flap

Treatment for breast cancer that is diagnosed in its early stages involves some sort of surgery to try to remove the entire tumour from the body. Studies have shown that using breast conserving surgery is just as effective as mastectomy in women who have one small tumour just in one part of the breast. However, if the tumour is a secondary recurrence of breast cancer, or there are several tumours in the same breast, removing the whole breast may still be necessary.

Breasts are such a major feature of a woman’s body that many women find a mastectomy a difficult operation to deal with. Fortunately, today’s breast surgeons are able to provide a range of different reconstructive operations that can either be done at the same time as the diseased breast is removed, or several months or years later.

Who Needs a Breast Reconstruction?

Women who have a lumpectomy to remove a cancerous tumour in their breast often do not need breast reconstruction. The amount of tissue removed does not change the size or volume of the breast substantially. If a larger amount of tissue needs to be taken away, and the woman has relatively small breasts, it may be necessary to put a silicone implant in place to balance the treated breast with the healthy one on the other side.

Most women who opt to have breast reconstruction do so after a mastectomy. Today, surgeons can leave free flaps of skin and muscle after they have removed the tumour, allowing this to be used with tissue taken from elsewhere in the body, sometimes in conjunction with a silicone implant.

How is a Latissimus Dorsi Flap done?

This is a method of reconstructing the breast using skin and muscle from the woman’s back. Because this is her own tissue, it is not rejected in the same way as transplant from another person, so it usually heals well. A piece of muscle with an attached blood supply and skin is removed from the latissimus dorsi muscle in the back, and then reattached to the breast area. The blood vessels are connected and the tissue then becomes pink as it receives oxygenated blood.

The tissue flap can either be sized to balance the size of the other breast, or it can be placed over a silicone implant. This is often done in a large-breasted woman as taking a large volume of back muscle would leave deeper scarring where the flap was removed.

The skill of the breast surgeon and a plastic and reconstructive surgeon is usually needed and the two specialists work together to make sure the end result is as natural as possible.

Scarring and the Latissimus Dorsi Flap

The surgery to remove the flap in the back and the surgery to reattach the flap in the chest causes some scarring but the incisions are well planned and the wounds are closed with fine suturing to minimise long-term scarring. Initially, the scars are dark red but these start to fade within a few months, becoming light pink or silver by 1-2 years. The incision made to remove the latissimus dorsi flap is a long diagonal one that follows the angle of the ribs, so this blends in with the natural contours of the back. The actual shape of the eliptical scar over the breast depends on how the original breast cancer operation was done. A few months after the breast reconstruction, most women choose to have a nipple reconstruction, which is a fairly minor operation to construct a small bud of tissue, which is then surrounded by a tatoo to simulate the areola.

A Latissimus Dorsi Flap and Radiotherapy

Many breast surgeons will advise women who need radiotherapy treatment after breast surgery to remove a tumour to wait to have their breast reconstruction. This is because the radiation damages tissue and can lead to problems with the tissue that has been transplanted. This is particularly true when a small amount of tissue is used to cover a silicone implant.

If a woman is having a completely autologous breast reconstruction, which has no implant, this has a much better chance of surviving well even if a course of radiotherapy is needed.

Other Methods of Breast Reconstruction

Since the latissimus dorsi flap method of breast reconstruction was developed, breast surgery has advanced significantly and it is now possible to have tissue flaps taken from the abdomen, thighs or buttocks. Tissue from the abdomen, in particular, is now favoured, as the volume of muscle and fat that can be removed is quite a lot bigger than that available in the back.