With this option, the tissue from the back (the latissimus dorsi muscle) is used to reconstruct the breast combined with an implant.
First, the tissue (located at the back of the shoulder blade) is brought around to the breast mound to create the new breast. Then an implant is inserted underneath the latissimus dorsi to provide the volume. Depending on the desired size, immediate or delayed reconstruction, an expander implant is placed in the first instance, replaced by a permanent implant at a later stage. The expander implant works by stretching the skin and tissue, so that it can accommodate a permanent implant. It can also create a more natural breast shape. The scar is usually horizontal, so it can be hidden under bra straps. Occasionally, it is diagonal and therefore more difficult to cover.
- Using the latissimus dorsi (known as an LD flap) with an implant reduces the risk of complications such as infections, implant extrusion (when the body rejects the implant), or capsular contracture (excessive or invasive scar tissue formation).
- It generally creates a more natural looking breast than using an implant alone.
- Patients can avoid scars on the tummy, buttocks and thighs.
- The LD flap combined with an implant is a popular choice for women with a larger breast size.
And the disadvantages?
- Because a muscle is removed from the back, some women may experience weakness in the shoulder. Although physiotherapy can help, the shoulder may never fully regain its former strength. This may be an important consideration for women who are very active, for example, those who swim, climb or play tennis or golf.
- Implants do not last a lifetime (and risk rupture) and therefore will need further replacement surgery at some point.