Breast reconstruction – Implant based, Latissimus dorsi flap

Implant Based

Breast reconstruction is a surgery performed to restore the shape of breasts after tissue is removed during mastectomy (surgery for treatment or prevention of breast cancer).

Breast reconstruction is performed by three methods:

Using a tissue expander/implant
Tissue flap reconstruction: using your own tissue (autologous)
Combination of both

Tissue Expanders and Implants

This is a common 2-stage procedure. The first stage involves the placement of a tissue expander in the pocket formed by the part of the breast removed during mastectomy. The expander is a saline (salt water) or silicone-filled balloon that is gradually inflated over a couple of weeks or months to allow breast muscles and skin to stretch to the desired breast size. This is then replaced by the permanent implant, which can also be filled with either silicone or saline. This preliminary procedure is done to ensure cosmetically desirable outcomes and avoid the risk of the implant coming out through the surgical incision or skin itself.

This method is suggested for women with small to medium-sized breasts with mild ptosis (sag), undergoing bilateral mastectomy, and having healthy mastectomy flaps. The outcomes may not be so favourable for women who are obese, have large breasts, smokers or those who have had breast radiotherapy.

Expander/Implant and Acellular Dermal Matrix (ADM)

More recently, expander/implant reconstruction is augmented with a surgical mesh called acellular dermal matrix, which cradles the implant and gives the breasts a more natural shape, contour and droop. The matrix is a very thin white leather made from human or pig skin that is extensively processed and preserved to ensure the safe insertion in human tissues.

The mesh can be used with or without the expander in a one-stage implant reconstruction, most often in conjunction with nipple-sparing mastectomy. This method may be more useful following preventive mastectomy in younger women.

Latissimus Dorsi Flap

Breast reconstruction after mastectomy (removal of breast tissue to treat breast cancer) can involve the use of an artificial implant or a flap of your own tissue removed from another part of your body and inserted into your chest. Latissimus dorsi flap is a flap of tissue containing the latissimus dorsi muscle that is located in the back, below the shoulder blade and behind the armpit, which helps in twisting and lifting your arm. The latissimus dorsi flap procedure involves using muscles, fat and skin from the latissimus dorsi area for breast reconstruction.

You may be recommended for a latissimus dorsi flap if you have small sized breasts, sufficient tissues in the latissimus dorsi area and previously undergone radiation. This flap is usually preferred because of its close proximity to the breast, making it less complicated to transfer the tissue while it remains attached to its original blood supply. However, you will be advised against this procedure if you participate in sports activities such as swimming and skiing, activities which depend largely on these muscles.

Latissimus dorsi flap procedure is performed under general anaesthesia on an inpatient basis. Your surgeon makes an incision near the shoulder blade and elevates a portion of skin, muscle, fat and blood vessels and moves it to the breast defect area through a tunnel formed under the skin. This tissue is then shaped into the breast mound. The blood supply is left intact. Your surgeon may also insert an implant under the flap. The incision is closed. The entire procedure takes about 4 to 6 hours to complete. You may be required to stay in the hospital for 4 to 5 days.

As with any surgery, latissimus dorsi flap insertion may involve certain risks and complications such as tissue breakdown, muscle weakness, lump formation and deposition of fluid under the wound.