Autologous Reconstruction LD Flap
There are many techniques for using your own tissue to reconstruct your breast. This can be done at the same time as the mastectomy (removal of the breast) or in a delayed fashion sometime after the breast removal. LD Flap – Latissimus Dorsi Flap – uses tissue from your back combined with a saline or silicone implant to reconstruct your breast.
HOW IT WORKS
Consultation and Planning
Once you decide on mastectomy with your breast surgeon, you will come in for a reconstruction consultation. At this meeting, we will go over the types of breast reconstruction and make a plan specific to your medical needs and your personal goals. We will choose what breast size (bigger, smaller, or the same) you want to be. To be a candidate for an LD flap breast reconstruction, you will need to have excess back tissue and this will be assessed at your consultation. We will coordinate surgery with your breast surgeon.
After the removal of your breast, there is not enough skin to create a similar sized breast. This is why tissue will need to be moved from your back. Dr. Grawe will make some marks on your back and your chest in the pre-operative area which will be used as a plan in surgery.
After the breast tissue is removed, you will be turned to your side while you are still sleeping. A small oval of skin and the underlying Latissimus Dorsi muscle will be removed from your back and tunneled over to your chest. The back area will be sutured closed in a straight line and then you will be turned over to your back again.
Usually an implant or tissue expander is also used under this tissue to create a larger breast. The LD flap helps create a very natural looking breast and camouflages the implant below. Drains will be placed in your back and must remain there for 2-4 weeks. This surgery takes about 3 hours.
You will stay in the hospital for 1-3 days after surgery. During this time, the nurses will check your newly reconstructed breast to make sure the blood supply to the new breast (LD flap) is good so that the tissue can survive in its new location. The nurses at the hospital will give you pain medicine, make sure you are not nauseated and can eat, and teach you how to take care of your drains and bandages before you go home. The drains will be removed at your follow-up office visit.
At home, you should not lift anything heavier than a gallon of milk for at least 2 weeks after surgery. You should walk around after surgery and NOT stay in bed. This is important to prevent blood clots. You may shower 48 hours after surgery. You should eat a healthy diet and as much protein as possible to promote good healing.
You may drive and return to work when you are no longer taking prescription pain medicine. Most people are able to return to a light duty job 2-3 weeks after surgery and may start exercising after 6 weeks.
Remember that everyone is different. Recovery time and progression is not the same for everyone. The times stated are typical for healthy individuals healing from this surgery. The normal progression of healing may be different for those with health problems, smokers, and those who have unforeseen complications after surgery.
Risks and Considerations
- Fairly short surgery – 2-3 hours
- Fairly fast recovery – 2-3 weeks
- Perky breast with soft, natural look and feel
With every surgery, there are risks involved including bleeding, infection, blood clots, pain, scarring, delayed healing and need for further surgery. Here are some complications specific to Latissimus Dorsi Flaps:
- Tissue expander type problems with weekly office visits.
- Implant based problems including the risk of capsular contracture.
- Use of an implant and another scar from the back donor site.