Lattisimus Dorsi Flap
The lattisimus dorsi flap utilizes excess skin, fat and the “lat” muscle on the side of the breast to be reconstructed. It involves taking an elipse of skin and fat and the underlying muscle from the back which is then tunneled under the skin of the axilla (armpit) to the front of the chest wall. The donor site on the back is then closed as a single scar along the bra line. This is indicated in patients who have had radiation so that the back skin can be used to replace the damaged, radiated skin of the chest wall.
The back skin in sewn superiorly into the old mastectomy scar and inferiorly into the inferior breast fold (inframammary fold). This often requires an underlying expander or implant to give enough volume to the breast. Patients who are not candidates for this procedure include smokers, elite athletes and those with a BMI>32.
Complications include capsular contracture, flap necrosis, infection, hematoma, seroma, DVT/PE, wound healing problems, asymmetry and implant maloposition.