What is a scarless latissimus dorsi flap breast reconstruction?
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Developed by Australian plastic surgeon, Dr Mark Lee at St John of God Hospital in Western Australia, the scarless latissimus dorsi (lat dorsi) flap is a new approach to the traditional lat dorsi breast reconstruction method that not only avoids scars to a woman’s back but also has been shown to have fewer complication rates, shorter operating time and good aesthetic outcomes. This less invasive technique may be particularly appropriate for women undergoing preventative skin and nipple sparing double mastectomies and seeking immediate reconstruction. |
The latissimus dorsi flap is stitched to the pectoralis major (a large muscle in the upper chest) and to the inframammary fold (the crease underneath the breast area).
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What stages are involved?
What is the expected recovery time?It can take 4-6 weeks to recover from latissimus dorsi reconstruction surgery and to resume normal activities.
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"After speaking with 2 plastic surgeons I chose the double Scarless Lat Dorsi as I didn't have enough tummy fat for DIEP and it made sense to not have 2 extra wounds to heal on my back and extra support to hold the implants in place. I also liked the idea it cut down the operation time by about an hour. I had viewed implant only pics at the breast clinic but preferred the finished look of Lat Dorsi. |
What are the risks?
Like all surgery, latissimus dorsi flap surgery has some risks. Many of the risks associated with latissimus dorsi flap surgery are the same as the risks for mastectomy. If you've had an implant inserted along with latissimus dorsi reconstruction, there are also risks related to implant reconstruction. However, there are some risks that are unique to latissimus dorsi flap reconstruction.
Tissue breakdown
In rare instances, the tissue moved from your back to your breast area won't get enough circulation and some of the tissue might die. Doctors call this tissue breakdown “necrosis.” Some symptoms of tissue necrosis include the skin turning dark blue or black, a cold or cool-to-the-touch feeling in the tissue, and even the eventual development of open wounds. You also may run a fever or feel sick if these symptoms are not addressed immediately. If a small area of necrosis is found, your surgeon can trim away the dead tissue. This is done in the operating room under general anesthesia or occasionally in a minor procedure setting. If most or all of the flap tissue develops necrosis, your doctor may call this a “complete flap failure,” which means the entire flap would need to be removed and replaced. Sometimes the flap can be replaced within a short timeframe, but in most cases the surgical team will remove all the dead tissue and allow the area to heal before identifying a new donor site to create a new flap.
Lumps in the reconstructed breast
If the blood supply to some of the fat used to rebuild your breast is cut off, the fat may be replaced by firm scar tissue that will feel like a lump. This is called fat necrosis. These fat necrosis lumps may or may not go away on their own. They also might cause you some discomfort. If the fat necrosis lumps don't go away on their own, it's best to have your surgeon remove them. After having mastectomy and reconstruction, it can be a little scary to find another lump in your rebuilt breast. Having them removed can give you greater peace of mind, as well as ease any discomfort you might have.
Muscle weakness
In some cases, you may have some weakness in your back, shoulder, or arm after latissimus dorsi flap breast reconstruction because some of your back muscle has been moved to your chest. You may have partial loss of strength or function that makes it hard to lift things and twist. This can affect your ability to perform certain swimming, golf, or tennis stokes, or turn and manipulate objects. If you have muscle weakness that is problematic and persistent, talk to your doctor to see if you can work with a physical therapist on these issues. Also, ask about exercises you can do to help strengthen the area.
Fluid under the back wound (seroma)
This is the most common problem which occurs with this type of surgery. Seromas usually get better with time and as the body heals, but sometimes they need to be drained by the surgeon, or another skilled health professional.
Tissue breakdown
In rare instances, the tissue moved from your back to your breast area won't get enough circulation and some of the tissue might die. Doctors call this tissue breakdown “necrosis.” Some symptoms of tissue necrosis include the skin turning dark blue or black, a cold or cool-to-the-touch feeling in the tissue, and even the eventual development of open wounds. You also may run a fever or feel sick if these symptoms are not addressed immediately. If a small area of necrosis is found, your surgeon can trim away the dead tissue. This is done in the operating room under general anesthesia or occasionally in a minor procedure setting. If most or all of the flap tissue develops necrosis, your doctor may call this a “complete flap failure,” which means the entire flap would need to be removed and replaced. Sometimes the flap can be replaced within a short timeframe, but in most cases the surgical team will remove all the dead tissue and allow the area to heal before identifying a new donor site to create a new flap.
Lumps in the reconstructed breast
If the blood supply to some of the fat used to rebuild your breast is cut off, the fat may be replaced by firm scar tissue that will feel like a lump. This is called fat necrosis. These fat necrosis lumps may or may not go away on their own. They also might cause you some discomfort. If the fat necrosis lumps don't go away on their own, it's best to have your surgeon remove them. After having mastectomy and reconstruction, it can be a little scary to find another lump in your rebuilt breast. Having them removed can give you greater peace of mind, as well as ease any discomfort you might have.
Muscle weakness
In some cases, you may have some weakness in your back, shoulder, or arm after latissimus dorsi flap breast reconstruction because some of your back muscle has been moved to your chest. You may have partial loss of strength or function that makes it hard to lift things and twist. This can affect your ability to perform certain swimming, golf, or tennis stokes, or turn and manipulate objects. If you have muscle weakness that is problematic and persistent, talk to your doctor to see if you can work with a physical therapist on these issues. Also, ask about exercises you can do to help strengthen the area.
Fluid under the back wound (seroma)
This is the most common problem which occurs with this type of surgery. Seromas usually get better with time and as the body heals, but sometimes they need to be drained by the surgeon, or another skilled health professional.
What are the costs?
Private hospital costs
Most surgeons charge AMA rates, (ie rates that the Australian Medical Association recommends) plus anaesthetic and theatre costs set by your surgical team and selected hospital. Additional costs may include a hospital excess, tests, post-surgery garments and medications.
Out of pocket expenses can vary widely and it is important that you request a written quote from your surgeon and anaesthetist before committing to any surgery. Breast reconstruction surgery is considered a reconstructive, not a cosmetic procedure, and is generally covered by private health insurance. If you have private health insurance cover you will need to review your policy carefully with your provider to determine exactly what is covered before proceeding.
Most surgeons charge AMA rates, (ie rates that the Australian Medical Association recommends) plus anaesthetic and theatre costs set by your surgical team and selected hospital. Additional costs may include a hospital excess, tests, post-surgery garments and medications.
Out of pocket expenses can vary widely and it is important that you request a written quote from your surgeon and anaesthetist before committing to any surgery. Breast reconstruction surgery is considered a reconstructive, not a cosmetic procedure, and is generally covered by private health insurance. If you have private health insurance cover you will need to review your policy carefully with your provider to determine exactly what is covered before proceeding.
Preparation advice
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Reviewed by:
Dr Mark Lee
MBBS FRACS (Plastic Surgery)
Reference sources:
www.markleeplasticsurgeon.com.au
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174076/
http://www.plasticsurgery.org/news/2014/scarless-flap-provides-new-alternative-for-breast-reconstruction.html
Dr Mark Lee
MBBS FRACS (Plastic Surgery)
Reference sources:
www.markleeplasticsurgeon.com.au
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174076/
http://www.plasticsurgery.org/news/2014/scarless-flap-provides-new-alternative-for-breast-reconstruction.html
