What Are my Options After a Failed LAT Flap?

Inflammatory Breast Cancer- 5/10 Radical Mastectomy on left then chemo & radiation. 4/11 Total Mastectomy on right & tissue expanders on both. Left expander failed. Swelling & numbness left arm. 11/11 expanders removed, LAT and implants put in. Now 4/12 lLAT has failed. I look like Frankenstein's monster! Tiny breast like bump on right-some smashed mess on left. Still have to wear padded bra with prosthesis on left. I HATE THIS! Also have bulge of something on back- lynmphedema? 

Doctor Answers 5

What are my options after a failed latissimus flap?

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Hello!  Thank you for your question.   After radiation, you have an increased rate of complications including wound problems, infections, thinning of the tissue, and decreased vascularity to the skin/tissue of the area.  The best method to reconstruct a breast following radiation therapy is with a flap.  The flap, which is skin, fat, and sometimes muscle, will serve to bring in healthy, well-vascularized tissue to the chest/breast area that will significantly ameliorate the radiation issues compounding the problem.  Microsurgical perforator flaps (such as the DIEP flap and SGAP/IGAP flap) are the newest and most-innovative procedures in breast reconstruction today.  As these are muscle-sparing flaps, the pain, morbidity, and complications such as those above, of these procedures are much less.  They are highly-complex procedures that few plastic surgeons performed and consult with one who is well-versed, trained, and skilled in these procedures if you are interested.  

There are many options to breast reconstruction including implant-based and flap-based procedures.  The complication rate with implants following radiation is reported as high as 60-70% in some studies.  Flap reconstruction is usually recommended, but there are several centers who perform implants following radiation with great success and results.  I typically prefer flaps, such as the DIEP flap.  Other flaps are the conventional TRAM, SGAP/IGAP, and, TUG.

You are a candidate for other procedures, if you are willing to continue with your journey for a reconstructed breast.  Flaps such as those above, including others, are available.  The decision to continue with this will be your decision and what you are willing to go through.  There are risks and benefits with everything that we do in Surgery - discuss the various options with a board certified plastic surgeon who will educate you on all of the options and help you to decided if breast reconstruction or which procedure will be best for you.  Hope that this helps and best wishes!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Breast reconstruction

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Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.

If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+

Options for delayed breast reconstruction

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I am sorry to hear about your postoperative course.  After radiation and failed implant and failed latissimus flap reconstruction, I would consider you for a possible DIEP flap or TRAM flap.  If you have excess skin and fat in your lower tummy and have ever thought about a tummy tuck, you may be a candidate for a DIEP Flap procedure.  However, you must be in good health to be a candidate for tissue only breast reconstruction using your excess belly tissue.  To learn more about your options, please visit our breast reconstruction website below.

Options fro Breast Reconstruction

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Sorry to hear about all of your problems, breast reconstruction can be very difficult in the face of radiation, and there are often many setbacks. I would encourage you to pursue the free tissue transfer option. This is where tissue from one part of your body is taken and placed in your mastectomy defect. This is a more complex operation but offers and excellent cosmetic result and can be used in the face of radiation. I would encourage to visit with your surgeon and discuss the free tissue transfer method of reconstruction.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 reviews

Delayed breast reconstruction post radiation

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I'm sorry you've had such difficulty with you breast reconstruction. Unfortunately, radiation may screw up the best reconstructions. In a previously radiated chest, you only available options will be autologous reconstruction wither either a free flap ( DIEP, IGap/SGap, gracious, etc.) or a Pedicled flap such as a TRAM. During your consultation with your plastic surgeon, he will be able to recommend and discuss which option will be best for you. This will be based upon your physical exam and treatment history.

Perry Liu, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 5 reviews

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.