LD Flap (Latissimus Dorsi Flap)

LD Flap, with Saline or Silicone Implant

A latissimus dorsi myocutaneous or LD flap is a breast reconstruction technique using an oval flap of skin, fat, and underlying muscle from your back, specifically below your shoulder and behind your arm pit. The main difference between this and other flap techniques is that the blood vessels remain connected; the flap is simply rotated from your back to your chest.

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(A) Skin, fat and all or part of the latissimus dorsi muscle are incorporated into a flap that is rotated and “tunneled” under the skin from the back to the chest. (B) In most cases, the LD flap is used in conjunction with a breast implant, as the flap itself does not have enough fatty tissue to restore volume adequately to a breast after mastectomy. Removing the latissimus muscle from the back can affect the strength and movement of both the shoulder and the arm.

A latissimus dorsi flap is an excellent choice for patients who are not good candidates for a DIEP flap, such as those who suffer from a hypercoagulable disorder, who do not have enough skin on the chest after cancer surgery, who have scarred, unhealthy chest skin due to radiation, who don’t have enough abdominal fat, or who have had previous flaps that have failed and need an alternative donor site.

Unless your natural breasts are on the small side, you may need either a saline or silicone implant placed under the flap in a secondary surgery. The right type of implant for you is a personal choice, but Dr. Fisher will go through all of the pros and cons of each during your initial consultation.

With the latissimus dorsi flap technique, you will have a scar on your back, but usually it can be hidden under your bra strap. There is also some loss of muscle strength and function that may reduce shoulder strength by 15%, making this technique inappropriate for certain patients, such as those who use a wheelchair, rock-climb, or play tennis.

Though the skin on the back is slightly different in color and texture than the skin on your chest, this flap creates an extremely natural-looking reconstructed breast. If desired, nipple reconstruction and/or nipple tattooing can be scheduled two to three months after your implant is in place.

To find out more about a latissimus dorsi myocutaneous flap, or any other breast reconstruction option, call our office to schedule a consultation.

 

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