Lattisimus Dorsi flap with no implants

I am waiting to undergo a bilateral mastectomy, with immediate reconstruction using LD flaps without any implants due to radiotherapy. I just wanted to ask if anyone else had had this type of reconstruction surgery, and if they were happy with the result. I am a little worried thay I will be disappointed. I don’t have very large breasts to begin with but I am concerned about the way I might look as my surgeon told me I could be smaller than I am. Can anyone advise me or tell me where I can see pictures of this procedure. Thanks very much

Hiya, I don’t have experience of this but I have had an LD flap reconstruction, with an implant, and did ask my surgeon recently if the implant could be removed altogether and a breast be moulded just using the flap instead. I also wanted a reduction on the other side. My circumstances have changed since then so this is not so much a priority but I have only found the implant to be an irritant. As for radiotherapy, I am about to have it to my reconstructed breast, with the implant, so my understanding is that while not recommended it is possible.

I hope someone comes along to help answer your question soon but, in the meantime, I wish you all the best in whatever reconstruction you decide to go ahead with.

Naz

Hi I had this procedure done 6 weeks ago. Like you I was advised not to have an implant not because of needing rads but because my consultant wanted to make sure they looked natural. I have to admit that I am smaller now than before surgery but my consultant promised me that I could have lipofilling later to pad it out! With clothes on you’d never know but when undressed and looking critically then I can see the difference. I’m just hoping I get to choose where he sucks the fat from!!

I had the LD flap with an implant and I started rads today. The policy on this seems to vary from area to area.

The main risk from the rads is that it will cause scarring of the tissue round the implant (capsulation) that can then contract, making the breast go firm and possibly distort and cause pain. This process tends to happen over a period of time. My PS says that approx 30% need surgery withing 5 yrs to correct it - they remove the scarred tissue and put a new implant in. This still leaves a better cosmetic result than with a delayed recon. My implant has a saline core and a port, so if I get mild capsulation, I can be ‘let down’ a bit.

Dx

Hi there, I had an LD flap immediately (with a skin sparing mastectomy, so a round scar where areola was rather than an ‘eye’ shaped one) and no implant for the same reasons. I was a DD and now am a ‘good C’ on the affected side (which had been my larger side) with the prospect of symmetry surgery at a later date to even me up a bit by reducing the healthy one. I am very pleased with my result - a good shape and although obviously firmer than a real breast is quite natural. Your plastic surgeon ought to be able to show you piccy’s - mine gets loads taken (without our heads!) and they are available to other patients to see.

Since you say you’re not large, I’d have thought they should be able to do a good job for you.

Feel free to PM me if you want to ask more details on any of this.

Take care.

Hi everyone thank you so much for your replies I feel a bit better about the whole thing now, REVCAT, I did ask my surgeon for pics but he didn’t seem to have any. Do you have any idea where I could see any on the net? Thanks again and wish everyone well xx

i have had radiotherapy to both breast but its LD flap plus expander implants my surgeon wants to use… i had WLE and rads to both sides but im a gene carrier so will be undergoing bilateral mx and recon at some point… hes not keen expander only but would do it but says the expander with the LD would give a better outcome.

i dont know anybody here who had an ld without an implant it doesnt seem to be so common here… my friends have either had rads before the recon following WLE or Mx or following immediate reconstruction.

i think the rads excuse is a poor one nowadays but some people prefer not to have anything unnatural in their body… some places can also do extended LD flaps which takes a larger amount of tissue and can give you a bigger bust but i dont think this procedure is commonplace.

if you are concerned about the options and outcomes you can always ask for a second opinion too remember.

Lulu

Hi Bravo Charlie - I’m amazed! My PS loves nothing more than getting photos done. You could try google images for ‘LD flap before after’(I know, never google…) or if you PM me a real life email I can send you one or two I took of myself… strangely I’m not about to put them on the www, the News of the World might be no more but it’s ethos lives on ‘Baptist Minister in Topless Photo Shoot’… I think not! It doesn’t seem to be possible to add photos to PMs or I’d send you some that way.

Edit: there are some sueful clips from a BBC documentary involving a German PS I know (no names of course) here: bbc.co.uk/programmes/b00mqglb hope it’s helpful