Summary
Breast reconstruction with an LD flap can be done immediately after mastectomy or as a delayed procedure after the patient has healed from mastectomy. This flap is a valuable source of soft tissue that may allow for a more natural looking and natural feeling breast than would be possible through implants alone. This flap is also very useful to salvage a previously failed breast reconstruction or to correct contour deformities secondary to prior lumpectomy and radiation.
The LD flap can provide sufficient tissue for a small breast reconstruction without an underlying implant in some patients. This is particularly true for men undergoing mastectomy to treat breast cancer. In most women undergoing LD flap reconstruction, a breast implant or tissue expander is placed under the flap in order to provide volume.
Types of procedures
- Pedicled LD flap with a breast implant: In most cases, when the LD flap is transferred to the front of the chest, it is secured over a breast implant.
- Pedicled LD flap with a tissue expander: The LD flap can also be placed over a tissue expander for patients that want a fuller volume breast. Once the expander is sufficiently filled, a final implant is placed at a second stage.
- Pedicled LD flap alone: For some patients, the LD flap can be used without an implant to provide a small volume breast reconstruction. Fat grafting can provide more volume at a second stage.
- LD free flap: In very rare cases, the LD flap may be done as a free flap, where the flap blood vessels are attached to blood vessels in the chest using an operating microscope.
Procedure details
- After mastectomy, the patient is positioned on their belly to expose the back
- Ellipse of skin and fat is elevated from the back along with the underlying LD muscle
- Flap is transferred to the front of the chest by tunneling the tissue underneath the skin on the side of the chest, just under the armpit
- The donor site for the flap is closed, and the patient is repositioned on their back
- Breast shape is created using the flap tissue
- In most cases, an implant or expander is used under the LD muscle to add volume
Risks & Benefits
Breast reconstruction with an LD flap is a proven technique that has been in use for decades. While activities of daily living are not adversely affected by this surgery, patients who are competitive athletes should be aware that they might develop some weakening of shoulder extension and adduction.
The primary benefit of LD flap breast reconstruction is that it allows for a more natural reconstruction as compared to the use of an implant alone.
Frequently Asked Questions
What will my recovery be like after surgery?
We use Enhanced Recovery After Surgery (ERAS) protocols that help ease the recovery for our patients after LD flap breast reconstruction. Patients can usually go home two days after surgery, even though both the front of the chest and the back of the chest need to heal, If needed, physical therapy can help speed the recovery process.
