LD Flap Breast Reconstruction - things to know beforehand.

With your permission, ladies, I have put together all that is and that we know for this procedure, the good and the bad. That is mostly because most of the surgeons try to dismiss and minimize any kind of complications or quality of life issues that this procedure may bring.

Things to be aware when deciding to have a Latissimus Dorsi flap breast reconstruction.

1. Latissimus Dorsi flap breast reconstruction is usually recommended to women who do not have enough fat tissue to do the TRAM, DIEP, GAP or any other reconstruction that requires fat pad transfer, or in the cased of a failed reconstruction of these techniques. It can be done with or without skin flap, depending if you need replacement of radiated skin or not. If you are not in the categories above, and your PS is trying to push for this procedure, do not do it. They are only trying to increase their portfolio or it might be the only technique they're good at. Search a second opinion.

The recovery is slightly longer than with other reconstruction procedures. The biggest pro for this procedure is the fact that most of the best and most natural looks are achieved through this type of flap.

2. The success rate is quite high, nevertheless, the more athletic you are the higher the chances that you will have severe issues after this procedure, some of them being as severe as to leave you disabled for life. Besides extremely low strength in your arms/hands, there are two major possible complications from this procedure:

a. one of the rare but serious complications is the herniated abdominal oblique (on the side of your waist) - that muscle can be injured (or at least the sheath of that muscle) during prelevation of the LD muscle. That can cause the abdominal oblique to herniate, causing thus a breach in the abdominal wall. Depending on the severity of the defect, you might have no serious issues but you may have intestinal obstruction and displacement of the kidney on that side. You will need surgery to correct that defect by placing a mesh - and you will have issues lifting any kind of weights above 5 lbs for the rest of your life.

b. The other complication is not so rare, it's very common, and started to be documented by spine doctors in the past few years, with the spine being pulled out of alignment due to the absence of the LD muscle as major muscle supporting the torso upright. So look at severe pain and possibly loss of function in your arms/hands as time goes by. Best is to start as early as you can exercises to strengthen the remaining muscles in your back so they can compensate for the missing LD.

3. Procedure and what to expect:

The muscle is cut from waist-high, lifted from your back, then tunneled under your arm and brought in the front, where it will be sutured close to your breast bone. Usually if there is an implant, the pectoralis major muscle will be stretched and brought down to cover the 1/2 top of the implant, the bottom 1/3 of the implant will be positioned under the serratus muscle (the muscle that covers your ribs) and the transplanted LD will cover pretty much the whole implant - sometimes under the other two muscles, sometimes on top, depending on that specific plastic surgeon's developed technique

You will have at least one drain per side reconstructed. on the side, close to your waist. Some surgeons can place up to 3 drains per side, one in the reconstructed breast area and another one on the back. If you feel any seroma accumulation that doesn't seem to be drained properly by the drain, INSIST on having it absorbed with a needle: contrary to what surgeons assure you, allowing the seromas to absorb by themseves will create a lot of scar tissue and this will make you uncomfortable later on, sometimes needing massage therapy to break that scar tissue (that in some cases may even interfere with your ability to take a deep breath)

4, The LD breast reconstruction most likely will add to the arms and hand weakness you already have from the mastectomy.

5. Things you will have to re-learn how to do or you might have problems doing - because the LD muscle is the one responsible for any pushing/pulling move you make: getting up/sitting down on a chair or even on the floor; turning around in bed; opening/closing jars and lids; swimming; playing tennis; getting on a horse; climbing a ladder.

6. From the esthetics points of view, you will have a lot of breast animation. Make sure to discuss with your PS the severing of the thoraco-dorsal nerve, the one that stimulates the LD muscle. Without that nerve cut, the muscle will never atrophy properly and you will have distortion of the breast every time you do a push/pull move. Talking of distortion of the breast, even with the nerve sectioned, your foobs will distort any time you are facing down holding yourself upright on your arms. Depending on how good your PS is, you will have a smaller or larger "underarm boob" as that is the LD muscle. Also, remember the bra overhang right behind your underarm? You will have that forever, even with a BMI of 15. Another bad esthetic but not so important as it's usually covered by clothing is a slight (and in time more pronounced) sagging of the skin along the spine going towards the sides, starting about right under shoulder-blade height all the way to your waist. That is because the muscle from under there is no more and nothing supports the skin. Also, you will have a relatively deep indentation about 2"-3" (depending on your size) on the side you had the LD flap reconstruction, as the spinal muscle (the one that goes up and down the spine) is still in place but the LD is not there anymore. You might also experience the "cowhide" feeling right under the skin in the area of prelevation of the LD muscle.

7. The scar tissue may give you a "corset" feeling, be it around your torso, if you had bilateral reconstruction, or just on the side you had it if you had unilateral reconstruction. There isn't much that can be done about the "iron corset" and massage therapy barely touches it.

8. Reported from members with unilateral LD flap reconstruction, if one has a unilateral LD flap done, there may be the feeling of one's body being pulled (twisted) to the side opposite the surgery side. Also, the inability to twist one's torso normally either direction until the proper myofascia release therapy is done on the back.

Ok, anyone else wants to add anything? I tried to get as many facts as I could.