What Can Be Done to Fix a LAT Flap That is Painful and Twitchy?

I had a bilat DIEP reconstruction in conjunction with a bilat mastectomy. One side had horrendous complication/infections and ultimately had to be replaced with a LAT flap about half a year later. The Lat Flap breast now twitches oddly if I move the same-side arm too much and I do have a bit of residual dull ache in my back where the muscle originally was. Can the muscle be reattached and a new reconstructed breast be made from another area of my body? Don't want TEs. What can be done?

Doctor Answers (3)

Twitchy latissimus muscle

+1

I agree with the other surgeons who have responded. Putting the muscle back is not even a possiblity at this point. The best solution is a fairly small procedure to divide the nerve to the muscle. This does cause the muscle to shrink somewhat, but it will still stay in position and keep the implant covered (it will just thin out). Over time the pain in your back will probably diminish. If the muscle thins out, a relatively non invasive way to add some bulk to the reconstruction is fat injection. I hope this helps.

Regards,

Daniel Medalie, MD


Cleveland Plastic Surgeon
5.0 out of 5 stars 10 reviews

You can have the nerve that causing the contraction transected.

+1
I am sorry to hear about your experience with the breast reconstruction. You are Better off to try to salvage the Lat. flap with cutting the nerve supply to the muscle. Reattachment of the Lat.muscle is possible but nit practical.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 51 reviews

Breast Reconstruction

+1

I do not think the answer is to return the Latismus Dorsi muscle back and reattach it. It is  a big surgery and will not help with the pain or twitching.

The twitching can be alleviated by transecting the nerve to the latismus Dorsi. But it may atrophy and the breast become smaller.

As far as other options in breast reconstruction, there are other free flaps like the gluteus maximus free flap.

However you already have a Latismus  muscle, work with your plastic surgeon to improve on your symtoms or improve on the results.

Samir Shureih, MD
Baltimore Plastic Surgeon

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