What is a breast reconstruction with latissimus dorsi flap?

A breast reconstruction is an operation to recreate a breast shape either at the same time (immediate) as you have your mastectomy (removing your breast) or at some time afterwards (delayed). Your surgeon will recreate a breast shape using the latissimus dorsi muscle, with some fat and skin from your back.

The Therapeutic Goods Administration (TGA) continues to review and assess breast implants available in the Australian market.

In September 2019, the TGA decided to recall and suspend a number of breast implants and tissue expanders due to a small risk of breast implant-associated anaplastic large cell lymphoma. The TGA provides a list of the affected products and consumer information on the recall and associated risks.

What are the benefits?

You should get a breast shape again. Most women who have a successful breast reconstruction are more comfortable with their appearance.

Are there any alternatives?

Using padded bras or bra inserts can give the appearance of a breast shape when you are wearing clothes.

It may be possible to have a reconstruction using only an implant.

It is possible to use tissue from another area of your body, usually your lower abdomen or sometimes from your buttocks, inner thigh or side.

What will happen if I decide not to have the operation or the operation is delayed?

A breast reconstruction will not improve your physical health. Your surgeon may be able to recommend an alternative to recreate a breast shape. Your healthcare team may be able to provide prosthetic and underwear fitting which may help with your body image.

If you are booked in for immediate reconstruction as part of your cancer surgery, you should not have to wait too long. Your healthcare team will talk to you about this.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes 4 to 6 hours.

Your surgeon will make an elliptical (oval) cut on your back, usually along the natural creases of your skin.

They will lift the latissimus dorsi muscle along with a small patch of skin that will be used to replace the areola (the darker area around your nipple) and nipple or some breast skin. They will keep the blood supply to the muscle, and move it under your arm to the front of your chest to create a breast shape.

Your breast cancer team will shape the flap into a breast shape on your chest.

If you need an implant your surgeon will create a pocket under the muscle to place the implant in.

Breast implants

All implants are made of an outer layer (shell) of silicone or polyurethane. They can be filled with silicone or saline (salt water).

If you have already had a mastectomy, or radiotherapy or if the reconstruction skin is tight, your surgeon may need to use a tissue expander. Over a number of weeks your surgical team will gradually fill the tissue expander with saline through a small tube (port) to stretch your skin and make your breasts similar in size.

Are implants safe?

There is no evidence to suggest that women with silicone breast implants have a higher risk of developing diseases such as breast cancer and arthritis.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. If you gain weight after your cancer surgery, this operation may not be considered safe.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the breast cancer team or your GP for advice.

You can reduce your risk of infection in a surgical wound by taking the following steps:

• In the week before the operation, do not shave or wax the area where a cut is likely to be made.
• Try to have a bath or shower either the day before or on the day of the operation.
• Keep warm around the time of the operation. Let the healthcare team know if you feel cold.
• If you are diabetic, keep your blood sugar levels under control around the time of your procedure.

What complications can happen?

Some complications can be serious and can even cause death.

General complications of any operation

• bleeding
• blood clot in your leg
• blood clot in your lung
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• acute kidney injury
• chest infection

Specific complications of this operation

Breast reconstruction complications

• developing a lump under your wound caused by fluid collecting
• developing a lump under your wound caused by blood collecting
• loss of the flap
• skin necrosis, where some of the original breast skin at the edge of your wound on your breast or back dies leaving a black area
• unnatural movement or twitching of the reconstructed breast when you use your arm
• difference in shape and appearance
• numbness or continued pain around your armpit or the inner part of your arm
• permanent numbness around the scar in the back and on most of the surface of the reconstructed breast
• stiff shoulder
• arm weakness

Fewer than 12 in 100 women will get a complication related to the breast reconstruction in the first 30 days.

Implant complications

• developing a collection of fluid (seroma) in the pocket where the implant is
• infection of the implant
• capsule contracture, where scar tissue that your body naturally forms thickens and tightens around the implant
• kinking and rippling
• rupture of an implant
• movement of the implant
• rare cancer (anaplastic large-cell lymphoma - ALCL)

Fewer than 4 in 100 women will get a complication related to the implant in the first 30 days.

Consequences of this procedure

• pain
• unsightly scarring of your skin

How soon will I recover?

You should be able to go home after 2 to 5 days.

You should be able to return to normal activities after 4 to 6 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Do not drive for at least 3 weeks.

If your surgeon needed to use an expandable implant, you will need to come back to the clinic regularly.

The shape of your reconstructed breast takes several weeks to settle.

Summary

A breast reconstruction with latissimus dorsi flap is an operation to recreate a breast shape. You should consider the options carefully and have realistic expectations about the results.

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