The latissimus dorsi flap is an important and very versatile flap for breast reconstruction. The latissimus flap almost always requires a breast implant to add volume to the breast reconstruction in order to match the contralateral breast. The latissimus dorsi flap can be harvested and transferred with a skin paddle to replace a missing nipple areola complex or it can be harvested without the skin paddle to replace the soft tissue defect that results from mastectomy. The donor site on the back can be oriented vertically, horizontally, or obliquely depending upon the orientation needed on the chest as well as the availability of donor site skin or fat present on the back.
When the latissimus dorsi flap is utilized, to reconstruct a breast, there is typically not enough soft tissue available to reconstruct an entire breast and an implant is required to replace volume. In rare cases, the latissimus dorsi flap can be utilized, and it can reconstruct the entire breast, or it can be used to reconstruct a lumpectomy defect.
In the case demonstrated in the photograph, the latissimus dorsi muscle was used to replace the nipple areola complex that needed to be removed and an implant was eventually placed to replace the volume needed in the upper pole of the breast. The implant utilized was a low-profile soft implant to minimize visibility of the implant in the upper pole of the breast. Patient satisfaction is generally quite high with the latissimus dorsi muscle flap and there is minimal donor site morbidity. To prevent complications of seroma, we encourage patients to consume a diet high in protein with 1-2 grams of protein/kg of body weight or ideal body weight.
