Breast reconstruction – the options explained

Posted: 23/10/2014


Breast reconstruction is commonly performed after a mastectomy and there are a number of different surgical options available including implants, tissue transfers from the tummy, thigh, bottom or back, or combination of the two.

When tissue is transferred from the tummy, thigh or bottom, the skin is removed and repositioned, with blood vessels being reconnected. However, the latissimus dorsi reconstruction method uses a muscle from the back with some overlying fat and skin. The latissimus dorsi (LD) flap is tunnelled under the skin below the armpit and put into position on the chest wall to create the shape of the new breast. To maintain blood supply, the main vessels remain attached to the body. The large surface of the muscle provides enough tissue to reconstruct a breast with projection and a natural shape.  

Sometimes, a surgeon will use an extended LD flap, taking a larger amount of fat with the muscle, so that an implant does not need to be used. However, the standard LD flap procedure is usually combined with the use of an implant to improve the final aesthetic appearance of the breast. The soft tissue of the LD flap allows complete coverage of the implant and helps to achieve a more natural looking breast than could be achieved from an implant alone. Nipple tattooing may also be used to complete the appearance of the reconstructed breast.

The LD flap procedure does leave scarring on the back where the muscle has been lifted and moved to the chest wall. This scar is usually horizontal and can be hidden under a bra strap but is sometimes more diagonal and difficult to cover. This scarring is obviously more extensive when an extended LD flap is used. Patients may also be left with a lump under their armpit, as the muscle from the back has been threaded underneath the skin to the front of the body with the tail of the muscle positioned under the arm. The skin from a person’s back is also a slightly different colour and texture from the skin on the chest so a colour variation should be expected. Finally, a loss of sensation is common and the reconstructed breast can feel numb.

Patients generally do not suffer from any major long-term physical limitations following this procedure and daily activities and most exercise can be resumed after the initial recovery period. However, this type of reconstruction is not recommended for those who participate in competitive sports such as rowing and skiing due to reduced muscle strength in the shoulder.   

Sarah Gubbins, associate in the cosmetic surgery team at Penningtons Manches LLP, commented: “As we recently had an enquiry about breast reconstruction using the LD flap, we undertook some research into the different methods available. When women have undergone a mastectomy, they can either use a prosthesis or have their breast(s) reconstructed. Depending on their specific circumstances, a reconstruction can either be performed at the same time as the mastectomy or a delayed  until a later date. If women decide to undergo a breast reconstruction, they must discuss the options with their surgeon so they can decide which type of breast reconstruction is most suitable for them as each type of procedure has its own benefits and limitations.”  


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