Part II: Flap-based reconstruction – latissimus dorsi
The excess skin, fat, and the latissimus dorsi muscle are harvested from the upper back. This flap is then tunneled under your axilla (armpit) to its new location at the breast area, with its blood vessels attached. The flap is then trimmed, shaped, and secured into place, once we have created a pleasing breast form, to recreate your breast. A tissue expander/implant may be added for additional volume, if needed, to increase the size of the reconstructed breast(s). Your back incision will be sutured closed, leaving a single incision along your back, often being hidden within your bra line.
A unique method of latissimus flap reconstruction that I have learned from one of the world experts in this type of breast reconstruction and which we now perform is the “volume-added” latissimus flap. This adds additional soft tissue when harvesting the latissimus dorsi muscle, increasing the amount of tissue that we use to reconstruct your breast(s). We have seen that using this type of latissimus flap reconstruction provides a more natural-appearing reconstructed breast, due to its additional volume, which optimizes the final aesthetic outcome. In some instances, a “volume-added” latissimus flap reconstruction may avoid using a tissue expander/implant, as this flap may provide adequate volume alone.
In addition, we have seen some excellent results from fat grafting procedures to augment the reconstructed breast. By simply performing some liposuction to harvest fat from unwanted areas of fat elsewhere on your body (e.g., abdomen, thighs, buttocks, etc.), we augment your breast to add additional volume or correct contour deformities. Fat grafting procedures are safe and also avoid the use of implants for the purpose of adding additional volume and create a breast of completely your own tissue. (The fat grafting procedure will be discussed in a separate post). This adjunct procedure is used to augment the volume of the breast, and may avoid the need for an implant – giving you a completely autologous reconstruction.
· Hospitalization: 2-4 days
· Advantages: Breast mound is present immediately; your own tissue is used
· Disadvantages: Flap complications; minor loss of shoulder range of motion (alleviated with exercise); additional scar on the back; may need implant if additional volume is needed
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