Frequently Asked Questions

Latissimus Dorsi / TDAP flap

 

Q: When is breast reconstruction with Latissimus Dorsi flap suggested?

A: Whenever there is not enough abdominal tissue to harvest a DIEP flap.

 

Q: Is it an immediate or a delayed reconstruction?

A: As for any other breast reconstruction technique, it depends on the needs of the general surgeon and, in particular, on the need to undergo radiotherapy. In this case it is necessary to procrastinate reconstruction untill therapy is over, since radiation on prosthesis and overlying tissues might produce a foreign body reaction.

 

Q: What kind of scars will result after the procedure?

A: An elliptical scar in the inframammary fold and a horizontal scar on the back, along the bra line, so it may be concealed. Sometimes it is possible to make a vertical incision along the side of the chest, resulting in a vertical scar in this site.

 

Q: Harvesting a Latissimus Dorsi flap will produce what kind of drawbacks on my back and on my movements?

A: The Latissimus Dorsi muscle participates in upper limb movements and, in particular, in the movement of the limb from a higher to a lower postition, i.e. adduction, as it happens in wall-climbing. The procedure will decrease the ability to make such movement of almost 3%-5%, thus it will not impair the use of the limb. Whether it affects posture or not is still under debate, however it is noticeable that other, more important, groups of muscles are responsible for maintaining back posture.

 

Q: If a prosthesis is inserted, what is the reason for using the Latissimus Dorsi muscle?

A: It is a quite legitimate question. The reason is mostly the final aesthetic appearance of the breast, being more natural-like and pleasant than a breast reconstructed with expander and prosthesis; indeed, tissue is included in order to obtain a nice, natural-like ptosis of the new breast. Moreover, if one has undergone radiotherapy, the use of the Latissimus Dorsi muscle, not being irradiated as much as the Pectoralis Major, improves body tolerance to the prosthesis.

 

Q: Will I need to replace the implant in the future?

A: Almost certainly, although latest generation prostheses are more durable, with a lifespan of up to 20 years. Anyway, in any breast reconstruction in which a prosthesis is used, its replacement will sooner or later be necessary.

 

Q: Will I lose breast skin's sensibility?

A: Tactile sensibility of the breast reconstructed with Latissimus Dorsi flap is slightly lower if compared with the reconstruction with DIEP flap, and is not nearly comparable to the skin sensibility resulting after reconstruction with expander and prosthesis.

 

Q: With TDAP flap, will I lose Latissimus Dorsi muscle function?

A: Absolutely not! In spite of the use of the Latissimus Dorsi vascular pedicle, the muscle belly and its innervation will be respected.

 

Q: With TDAP flap, will I need a drainage tube?

A: Yes but only to the anterior mammary region, while it is not necessary at all to the posterior donor area of the flap.

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Redazione Barbara Fabiani