Breast Reconstruction with Latissimus Dorsi (LD) Flap
Latissimus Dorsi (LD) flap is a flap of tissue containing the latissimus dorsi muscle that is located in the back, below the shoulder blade and fat and skin overlying the muscle.
The flap is tunnelled under the skin of the armpit and is brought to the front of the chest to reconstruct the new breast. The blood supply to the flap is kept intact as the flap vessels are located in the armpit area. This flap tissue is then shaped into the breast mound.
If there is not sufficient tissue in the LD flap to match the opposite breast, then a breast implant can be placed underneath the flap at the time of the reconstruction to increase the size of the new breast. An alternative way of increasing the volume of the reconstructed breast is to perform fat grafting at a later stage when the flap has healed and settled well.
Symmetrisation surgery to the opposite breast (breast reduction or uplift/reshaping) may also be required at a later stage.
One complication specific to LD flap breast reconstruction is fluid collection in the back area (seroma) which often requires needle aspiration in the outpatient clinic by the surgeon. Complete flap failure is very rare as the blood supply to the flap remains intact during the transfer of the tissues from the back to the front of the chest. In most patients no functional deficit of the shoulder for everyday activities is noticed as several other shoulder muscles will compensate for the function of the latissiumus dorsi muscle once this has been moved from the back to reconstruct the breast.