My surgeon says women do fine without a Lattisimus muscle and that women will lose strength anyway in their ab. area from a DIEP, since abdominal muscles are cut through and poked around anyway.
DIEP Flap Vs. LAT Flap for Least Loss of Muscle Strength?
Doctor Answers (6)
Breast Reconstruction Options
There are many options for reconstructing your breasts. Each option has its advantages and disadvantages. DIEP, if performed by an experience microsurgeon who knows what they are doing, will not cause you to lose strength and result in abdominal weakness. Unlike TRAM procedures where your rectus abdominus muscles are sacrificed during the reconstruction, this does not happen with DIEP procedures. Lattisimus muscle reconstructions can be considered a hybrid between autologous and implant reconstructions. The volume from the reconstruction comes from implants, but you own autologous tissue from your back is recruited to try and mask the implants and make it feel more like your own. Given the advances in reconstructive techniques, we are able to create natural looking breasts with both implants and alloderm or with autologous tissue. It is best to discuss your options with a experienced plastic surgeon who is experienced with breast reconstructive procedures and decide which option is best for you.
DIEP VS. Latissimus Flap Breast Reconstruction
A DIEP flap, if successful, is vastly superior to a Latissimus Dorsi flap in Breast Reconstruction. Using the LD flap involves a visible back scar, needs to be used along with a breast implant and is associated with weakness in pushing oneself out of a deep chair. A DIEP flap is not associated with muscle weakness, the need for a breast implant and has a much more acceptable scar than the one associated with LD flap breast reconstruction. HOWEVER - performing a DIEP flap requires specialized microsurgical skills and not all insurance companies cover these procedures.
Peter A Aldea, MD
DIEP Flaps is by far the more superior procedure but not all surgeons do a true DIEP
The beauty of the DIEP flap is that it is supposed to leave your rectus muscle untouched. Unfortunately in my opinion too many surgeons cut the muscle or nerves to the muscle during the procedure thus weakening the muscle sometimes to the point that the procedure is no better than a Free TRAM procedure.
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DIEP flap if you a candidate is more challenging and rewarding
Lat. flap is an easier option for the surgeon and patient but not comparable in the donor site scar and muscle loss to DIEP. You will get have scar over lower abdomen that easily cover in comparison the back scar. The other concern with the Lat. flap is the lateral fullness and need for implant. If your surgeon feel more comfortable with Lat.,do not push him/her to do other flaps that are more complex and need micro surgery. DIEP is a difficult flap and not plastic surgeon are trained to do it.
Simpler approach to breast reconstruction is implants
Without knowing any details of your specific case, the best way to avoid compromizing muscle function in breast reconstruction is with an implant. Often the use of an acellular dermal matrix such as Alloderm is helpful. If you have had radiation treatment, then a flap procedure might make the most sense but in general your quickest recovery time and least effect on function uses an implant.
DIEP flap vs Latissimus Flap and impact on muscle strength
A DIEP flap is a muscle-sparing procedure that utilizes your excess skin and fat in your lower abdomen to reconstruct your breast. It saves your abdominal wall muscles (rectus muscles). There is no need for an implant to reconstruct your breast.
The latissimus flap takes the muscle skin and fat from your back to help reconstruction your breast in conjuction with an implant. Although the latissimus procedure takes the entire muscle, studies have shown that there are no long term functional or strength defecits to the shoulder after this procedure.
Hope this helps.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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