share

feedback

Your Breast Reconstruction Option:

Back Flap (Latissimus Dorsi Flap)

If you have had radiotherapy to your chest, your skin may not be able to heal or stretch as well as it used to. Putting a cushion between the implant and the damaged skin can make the implant surgery safer. Healthy skin, fat and muscle can be taken from your back to make this cushion. This may help reduce scar tissue from growing around the implant. An implant may not be needed if there is enough skin and fat to make the breast mound.

  • Surgery time: 2–3 hours each breast
  • Hospital stay: 1–3 nights
  • Home care: Drains and dressing changes
  • Recovery time:
    • Expander 3–4 weeks
    • Flap 4–8 weeks until back to regular activities

When it is used

Tissue from the back may be used when:

  • Women have had radiotherapy to the chest skin and muscle (chest wall tissue)
  • Chest wall tissue that is not in good condition
  • No extra skin, fat and muscle on abdomen or buttocks can be found

When it is not used

Tissue from the back may not be used when:

  • Muscles in the armpit or back have been damaged from past surgery
  • Blood vessels in the armpit or back have been damaged from past surgery

Pros

  • Healthy tissue to cover the implant
  • Less chance of scarring around the implant in the pocket

Cons

  • Can have possible problems of implant surgery and own body (autologous) tissue reconstruction
  • Both sides do not look the same (asymmetry)
  • A scar is left on the back
  • Shoulder may feel weak
  • Mild weakness in rowing or climbing activities
  • May have weakness using crutches

Potential Complications

Complication Treatment

Fluid that collects in a space (Seroma)

This often occurs in the back where the muscle was taken (donor site). The fluid collects in the space where the muscle used to be. A drain is put in place. It will need to stay in place for several days to weeks.

Flap does not survive (Flap necrosis)

Part, or, the entire skin and muscle may not survive. The dead tissue will need to be removed. This may be done in the clinic or the operating room.

Open wounds may need wound care for a long period of time.

Infection

You will need antibiotics and surgery. Doctors will likely take out the implant.

Bleeding or Bruising (Hematoma)

Iron supplements are needed in most patients. Blood transfusions will be needed if a lot of blood is lost.

Surgery is needed to drain a hematoma.

Pulmonary embolus (PE), deep vein thrombosis (DVT)

Blood clots may form in the legs and lung. Anti-clotting medication is given after surgery to protect against this. Long-term anti-clotting medication is needed if this occurs.

Problems with the pocket (Capsular contracture )

Surgery to deal with the scar. Implant may need to be changed.

Implant moves out of position (Implant malposition )

Surgery to reposition the implant

Implant breaks or tears (Implant rupture)

Surgery to remove and change the implant.

Implant breaks through the skin (Implant exposure)

Surgery to remove the implant.

Movement of the muscle (latissimus dorsi)

Surgery to cut the nerve

Both sides do not look the same (Asymmetry)

There may be a difference in size and shape between the two breasts. It is nearly impossible to match the other breast in shape and position. Another surgery (balancing surgery) with a local anesthetic may be needed to fix this.

Scars

Scars are present.

Scars may be raised, red and very itchy.

FAQs

  1. How long will my scar be?

    10–20cm. A little bit lower than your shoulder blade.

  2. Will the arm on the side of the surgery be weak?

    Patients with an average level of activity do not complain of a weakness. During strenuous activities such as rowing, climbing, or swimming some patients may notice a difference.

Special Considerations: Surgery to Balance the Other Breast

The main goal of breast reconstruction is to create a breast that looks nice and matches the other one. It is hard to make them match perfectly. Every effort is made to make them match as closely as possible. Surgery to correct the shape and size of the other breast is often done to help match the new breast.  This type of surgery can also be used in women who had only a part of their breast removed (lumpectomy, partial mastectomy) to improve the shape of the partial breast defect.

Breast Lift (Balancing mastopexy)

The nipple and breast tissue are placed in a higher position with some skin removal to match the reconstructed breast. The overall effect is a higher and firmer breast mound. Fat and breast tissue are not removed; therefore there is very little change in size.

Breast Reduction (Balancing reduction mammoplasty)

Through the same incisions as a mastopexy, skin, fat, and breast tissue are removed in order to match the size of the other breast or the size desired by the patient.

Balancing augment mammoplasty “Breast Implants”

In women with small breasts, putting an implant in the other breast can help to create balance. This can be done at the same time as the reconstruction or at a later date.  This should not interfere with cancer treatment or follow-up.

 

Special Considerations: Nipple and Areola Reconstruction

Nipple and areola reconstruction are the last steps of breast reconstruction. This is done after the breast mound reconstruction is finished and the woman is happy with the way it looks. This is usually done six months to one year after the breast mound reconstruction.

There are generally two parts:

  1. Making the nipple mound
  2. Adding colour

For women who do not want any more surgery, tattooing alone is an option to add color and shading.

In certain cases, at the time of the mastectomy, the nipple and areola can be saved. This should be discussed with the breast cancer surgeon.

Nipple Mound Reconstruction

There are many techniques that can be used. Most commonly, the tissue in the breast mound is raised and folded to create the nipple. This is a small surgery. It can be done in an operating room but is often done in the clinic using local freezing. Some examples are shown below.

Local Flaps

The nipple is created using only the skin and fat over the breast mound. Examples of flaps may include the “C-V” flap, and the “Double Opposing Tab” flap.

Pros:
  • Easy to do. Done under local anesthetic.
  • No skin grafts are needed
Cons:
  • Smaller nipple mound long-term, may flatten over time
  • Coloring needed to match the natural areola

Local Flaps with Skin Grafting

Skin and fat are taken from the breast mound to make the nipple. A skin graft is needed to cover the area taken. This is usually taken from an area where a scar already exists such as the abdomen or other breast. It is also used to reconstruct the areola. An example is the “Skate” flap.

Pros:
  • Nipple is more visible and lasts longer over time.
Cons:
  • Skin graft needed, possibly creating a new scar
  • Often needs to be done in the operating room under a general anesthetic.
  • Risk of graft loss
  • Bulky dressings that cover the area
  • Coloring often needed to match the natural areola

Free nipple graft

In certain cases, a part of the nipple on the other breast may be taken to create a new nipple on the reconstructed breast.

Pros:
  • Better match to the natural areola
Cons:
  • Small scar on the nipple donor site
    • Risk of graft loss
    • Donor nipple may lose some sensation

Areola Reconstruction

Grafts

The areola may be reconstructed using the skin from the other nipple. The goal is to get both areolas to match as closely as possible. A skin graft from the abdomen may also be used to create the new areola. Tattooing may be needed to match the color.

Tattooing

The nipple/areola color is added as a tattoo on the flap skin to match the natural color. Tattooing can be done with or without a nipple mound creation. Usually a local anesthetic is used before the tattooing starts. Touch-up tattooing may be needed to reach or maintain the desired color.

  • Tattoo time: 20–30 minutes each nipple
  • Recovery time: 1–2 days, Moisturizing ointment and dressings are applied for several days

View diagrams