Latissimus dorsi or the great back muscle is used in breast reconstruction as a salvage procedure after failed reconstruction or when microvascular autologous tissue transfer is not an option. Usually, the amount of transferred tissue is insufficient. Therefore it is commonly combined with silicone implants.
The primary indication is reconstruction in very thin patients after radiation or after implant extrusion. However, it offers an inferior aesthetic result compared to free tissue transfer.
The main bulk of tissue is provided by the transferred muscle. However, the nerve supply is cut and due to inactivity of the muscle slowly atrophies which significantly reduces its volume and the shape of the reconstructed breast. Therefore in case of unilateral reconstruction, additional procedures for symmetrisation after approximately 12 months are inevitable.
Surgery duration: 1.5-2 hours
Average hospital stay: 3-5 days
Total recovery time: 4 weeks
When would I be able to move about, walk and drive?
Patients should expect to be walking multiple times the day after surgery and can gradually increase walking time and distance as they feel comfortable. By day 3, most patients can head home. Driving shorter distances can generally be resumed after 4 weeks.
When would I be able to exercise again?
After about 4 weeks and after about 8 weeks with the upper body
Where will the scars be on my body?
Scars will be located around the breast, as well as an additional horizontal or oblique scar on the back, near your scapular bone.
Compression garments and bra?
You will need to wear a compression garment for your donor are for 3-4 weeks. In the first or two week, it is recommended to wear a sports bra.
Will I need any additional procedures?
Reconstruction is typically finished several months after flap transfer with nipple reconstruction and areola tattooing. To achieve the best result sometimes, additional procedures might be needed, such as liposuction, fat transfer, correction of scars, procedures for symmetrisation on the other breast. A significant advantage of autologous reconstruction is the ability to reshape the breast at a later stage to the best final results with a variety of different techniques.
In almost all unilateral reconstructions additional procedures for symmetrisation are necessary due to muscle atrophy.
Which are most common technique-related complications?
How does the procedure look?
During the procedure, the muscle and the overlying tissue (skin and fat) are mobilised on vascular pedicle which is not divided. A so-called pedicled flap is then rotated through the skin tunnel forward, around the chest. It is then shaped along with the residual tissues to achieve a breast shape. Drains are inserted, and wounds are closed in layers.