In some instances, natural tissue reconstruction is performed using tissues from other areas of the body. These additional donor sites include the shoulder blade area (latissimus dorsi muscle flap), the outer thigh, the inner thigh, and the buttocks (superior and inferior gluteal muscle flaps). In the hands of most plastic surgeons, these sites are used less often than TRAM flaps. With the exception of latissimus dorsi reconstruction, these additional flaps are all performed as free (microsurgical) procedures. As with the free TRAM described earlier, these free flap procedures involve completely detaching the tissue from the donor site and re-establishing the flap's circulation by reconnection of flap blood vessels to a local artery and vein at the breast site. By contrast, reconstruction with the latissimus dorsi muscle from the shoulder blade area involves tunneling the tissue to the front side of the chest for use in the reconstruction of a new breast.

Latissimus Dorsi Flap Reconstruction

One of the available donor site options for breast reconstruction is the latissimus dorsi muscle, or the muscle next to your shoulder blade. By "tunneling," the flap tissue muscle and skin covering it ("skin island") are brought around from the back of the body to the front and are placed at the mastectomy site. Because there may not be enough "filler" in this area of the back to match the size of the other breast, this procedure may also require the placement of an implant.

Generally, this donor site is used in cases where the abdominal tissue is not suitable for use in reconstruction. This donor site may also be used in cases where the abdominal tissue was previously used for reconstruction, but the newly reconstructed breast was partially or completely lost due to complications. Some plastic surgeons may recommend latissimus dorsi reconstruction even if the TRAM donor site is available.

Many of the same concerns exist for this surgery as for the TRAM surgery. A hospital stay of three to five days may be required. The same general recovery time applies for this procedure as the TRAM procedure.

How is Latissimus Dorsi Flap Reconstruction Done?

A flap of skin and muscle is separated from the shoulder blade area.

The flap is tunneled from the back of the body to the mastectomy site.

The flap is shaped into a reconstructed breast. An implant is placed under the chest muscle to give the breast fullness.

The donor site on the back is stitched closed.

Advantages of Reconstruction Using the Latissimus Dorsi Muscle:

The tissue area and the blood vessels involved are large and dependable, making it likely that the operation will be successful.

Disadvantages of Reconstruction Using the Latissimus Dorsi Muscle:

You may need to have an implant placed under the flap to create a large enough breast.
The surgery may leave a sizeable scar in a potentially prominent area of the back. This scar may be particularly easy to see on women wearing swimsuits and summer clothes.