Latissimus flap reconstruction
This procedure can be performed when the quality of the chest skin is not good enough to support an implant alone. During breast reconstruction surgery, the implant needs to be covered with good quality tissue (skin and fat). After a mastectomy, if there is too little skin or it is too fine, or if there are sequelae from radiation burns, healthy skin is necessary to cover the implant
This reconstruction technique combines a latissimus flap and an implant in order to reach volume and a natural fall. The scar situated in the back will be hidden under the bra and will be as discreet as possible.
A flap is made of tissues vascularized through their own vessels, artery and vein, and, contrary to a graft, the flap is immediately living.
Patients for whom the latissimus dorsi muscle is essential cannot undergo this procedure: paraplegic patients that use it to move their wheelchair and patients who do climbing, activity during which the latissimus dorsi muscle is under a lot of strain.
The procedure
The surgery is performed under general anesthesia and lasts between 3 and 5 hours. Patients usually stay 5 nights in the hospital.
The first step of the surgery is performed on the side, and consists in removing the flap through a horizontal incision, which will be hidden under the bra. In the second part, the patient is in a semi-upright position so that the surgeon can preview the result in a standing position.
After the procedure
The garment is changed on the 2nd day and replaced with a soft front-fastening sports bra, which will be worn for at least 1 month. Drains will be left in place in order to reduce any bruising and they will be removed between the 3rd and the 6th day after surgery. The pain, which is of variable intensity, is always treated preventively and according to the needs of the patient. In most cases, the unilateral sampling of latissimus dorsi does not create any significant functional discomfort in everyday life.
It is highly recommended that postoperative physiotherapy be undertaken rapidly in order to restore optimal mobility in the arm and reduce the risk of post-operative pain.
The reconstructed breast is supple and more or less voluminous. Over time, its evolution will be the same as the natural evolution of the contra lateral breast. The implant should be replaced after about 10 years.
A symmetrization of the contra lateral breast may be considered about 3 months after a latissimus flap reconstruction, breast ptosis or breast reduction, as well as a reconstruction of the areola and the nipple.
The first shower is permitted the day after the surgery but baths should be avoided during the first month. The scars need to be protected from the sun for the first year following the surgery!
