I'm Suppose to Have a Lat Flap and Am Wondering How Safe is the Procedure?

and how long of a recovery is it after..?

Doctor Answers (11)

Is the Latissimus Dorsi Flap Breast Reconstruction Safe?

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The Latissimus dorsi flap breast reconstruction is a safe and reliable flap.

Unless used without an underlying breast implant, it is usually only suitable for reconstruction of small breasts.

When the breast implant is combined with the latissimus dorsi flap it adds the potential complications of a breast implant.  These complications include breast  implant infection, breast implant exposure, breast implant capsular contracture, and breast implant rupture.

If your breasts are too large for a latissimus dorsi flap alone, and you do not want to use an underlying breast implant, then another flap breast reconstruction such as a TRAM flap or DIEP flap should be considered.

New York Plastic Surgeon

Latissimus Flap Breast Reconstruction

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The latissimus dorsi muscle is the large muscle you can feel on your back when you push your shoulder down.  It is an excellent choice for breast reconstruction.  The main reason is that it has an incredible blood supply and therefore it is much more sturdy than other tissues.  It is also a great muscle to use in post radiated breasts.  Again due to bloody supply.  However, there are a few things to consider.

First, you will have drains in your back that can take several weeks until they are ready to be removed.  And even with the drains the risk of seroma formation is still higher than with other flaps.  Not a huge deal but bothersome as you will need the seroma drained every few days.  Second, the loss of the muscle will result in weakness, on that side, with arm pulling motion such as ladder or rock climbing.  Finally, it is a large but relatively thin muscle and therefore can rarely be used alone.  Most of the time it is used in conjunction with an expander that will later be replaced with an implant.

Overall I am a huge fan of this muscle because of its reliability.  I used to use dermal matrices but had many problems so I want back to using the latissimus and have been happy ever since.

Lat Flap, how safe?

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Thank you for your question. The Lat Flap has been around for a long time and has a proven track record for breast reconstruction.  Although in the category of less elegant flaps, it serves an important role in a plastic surgeon's armamentarium of possible flaps for breast reconstruction.

It is a safe surgery in that your main risks will be risks associated with any medical conditions you have and the typical risks of any surgery (bleeding, infection, scars, etc...) and anesthesia risks.  Specifically, the Lat flap has the possible risk of a fluid collection forming on the back from where it was taken. Total flap loss is pretty rare for this surgery unless somehow the blood vessel keeping it alive is not available from previous surgeries.

A typical recovery is off pain medication, driving, and back to a desk job at 2 weeks, sometimes 3.  Ask your surgeon what his/her specific instructions are. I defer to your surgeon for all specific instructions, as she/he has had the advantage of evaluating you and doing an examination.

I hope this helps at least somewhat.  Best of Luck!

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 47 reviews

Latissimus Dorsi flap and recovery.

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The latissimus dorsi flap operation is a very safe and reliable operation. My patients tend to spend 1 evening in the hospital and go home the next day. I have found the use of a pain pump (On-Q) in the back to be helpful in reducing overall recovery times. The procedure typically takes several hours, however major complications are rare.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 12 reviews

Latissimus dorsi flap

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Latissimus dorsi flap is a very common flap used for breast reconstruction and wound coverage for large wounds.  As this is a commonly used flap, it is likely 'routine' surgery and so your surgeon and nursing team should be well familiarized with the procedure.  Surgical risks should be minimal.  The recovery may take a while.  You will likely have drains that may have to stay in place for up to 2 weeks.  The recovery is also governed by what the flap is being used.  Follow your surgeon's instructions carefuly to ensure that the blood flow to the flap is no interfered with.
Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 213 reviews

Latissimus dorsi muscle flap

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The LD flap is used mainly for breast reconstruction, and these days it is often reserved as a " life preserver" or back up for emergencies when other flaps have failed, or the patient had radiation injury from previou reconstruction.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

This is a safe flap

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The indications for the Lat. Flap is limited because of the small amount of fatty tissue over the muscle. This is used usually in combination with implant for breast reconstruction. The most common flap for breast reconstruction is free TRAM,free DIEP and GAP flap. There may be a specific reason that your surgeon has decided to do the Lat. flap including your medical conditions,avalability of the abdominal tissue and your expectations.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.5 out of 5 stars 66 reviews

Lat flap for breast reconstruction

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The Latissimus flap is an excellent option for reconsruction.  It is not done that frequently today because it requires an intraoperative change in position.  It is most commonly used to salvage other failed reconstructions and it may be offered  if a patient requires radiation therapy and is not a candidate for autogenous recostruction. The most reconstructions performed today are expander/ implant reconstructions and  TRAM reconstructions.  Good Luck

Beverly Friedlander, MD
Short Hills Plastic Surgeon
5.0 out of 5 stars 10 reviews

The Lifeboat.

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The latissimus is a great procedure. Studies show that at one year there is no deficit in activities of daily living and there is minimal if any late pain. The shoulder girdle muscles take over the function and range of motion and strength are largely maintained. I try to reserve it for when the patient has already been radiated, but will use it in the setting of poor baseline mastectomy flaps. It is a good lifeboat to get the patient out of trouble in a variety of situations. Best wishes.

Mark D. Wigod, MD
Boise Plastic Surgeon
5.0 out of 5 stars 1 review

Latissimus flap breast reconstruction

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As Dr. Aldea said, the latissimus flap is a workhorse for reconstructive plastic surgeons.  Non-survival of this robust flap is exceedingly rare and the main risk is a fluid collection in the back which resolves with time and treatment.  The functional compromise by losing this muscle is mainly seen in swimmers and cross country skiers or in pushing up from chairs.

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.