This is another tissue-flap procedure performed immediately after a mastectomy. An oval section of tissue – made up of skin, fat, and the latissimus dorsi muscle from the upper back – is detached and slid around to the breast area through a tunnel under the skin. Blood vessels remain attached whenever possible.
The tissue is shaped into a natural-looking breast and sewn into place. If blood vessels have been cut, with the aid of a microscope Dr. Meade surgically reattaches them to blood vessels in the chest area. The entire procedure usually takes two to three hours.
In general, this procedure is recommended only for a woman with small- to medium-size breasts, because there is so little body fat in the upper back. An implant (inserted during the same operation) is usually necessary to create a breast of moderate size.
An advantage of the procedure is the relative ease with which the flap of tissue can be slipped around to the front, shaped, and sewn into place. Removal of the latissimus dorsi does result in some unevenness in the appearance of the back. However, back function and strength usually are not affected.
“Are there any medical conditions that would disqualify a patient for this procedure?”
Because healthy blood vessels are so important to the viability of the reconstructed tissue, the latissimus dorsi procedure – like other flap procedures – is usually not offered to smokers, or to women with diabetes or vascular disease.
“Can anything be done to make the scar on the upper back easier to hide?”
Depending on the patient, the scar from the flap-donor site on the back can be aligned either diagonally or horizontally. A horizontal scar can usually be concealed under a bra strap.