Breast Reconstruction with Autologous Tissue and Implant
Post-mastectomy breast reconstruction using the latissimus dorsi flap and implant is one of the reconstructive methods that provides superior, long-lasting aesthetic results and is equally safe, with rare complications.
WHEN DO WE CHOOSE RECONSTRUCTION WITH AUTOGENOUS TISSUE AND IMPLANT?
In cases where radiotherapy was necessary after mastectomy, the irradiated area undergoes significant changes in skin and soft tissue quality, becoming thin and less elastic. In these situations, reconstruction with a direct implant or expander can often lead to immediate complications such as partial necrosis, implant exposure, or delayed complications—most commonly capsular contracture.
WHAT DOES THIS TYPE OF RECONSTRUCTION INVOLVE?
The new breast consists of a silicone implant placed under the pectoral muscle, with the latissimus dorsi flap shaped over it. This flap is a complex structure of autologous tissue taken from the back, consisting of skin, fat, and muscle, nourished by its own thoracodorsal vessels. This way, we combine the patient’s tissue with the breast implant to achieve a breast with superior cosmetic characteristics.
The surgery is performed under general anesthesia and lasts on average between 2.5 and 3 hours. At the end of the operation, 2 drains are placed to remove excess fluids that may accumulate later. Drains are usually removed after about 5 days. Hospitalization lasts between 2 and 5 days.
MAIN ADVANTAGES OF THE LATISSIMUS DORSI FLAP RECONSTRUCTION METHOD
- can be used in challenging cases with prior irradiation
- can be used for both immediate and secondary reconstructions
- has a 97% success rate
- applicable to nearly all cases
- useful when there is no excess abdominal tissue or in presence of abdominal scars
- the contribution of autologous tissue reduces the risk of capsular contracture
- shape, projection, and degree of ptosis are similar to a natural breast
- breasts of various sizes can be achieved, up to a C cup
- consistency is similar to a healthy breast
- only a single intervention, unlike expander/implant methods
- recovery is faster than with abdominal flap reconstruction
- return to social and professional life is relatively quick: 3–4 weeks
- donor site scar is well hidden in the bra line
- appearance improves over time
- follow-up ultrasound monitoring is simple
WHEN CAN THIS TYPE OF RECONSTRUCTION NOT BE DONE?
There are several major contraindications:
- smoking
- obesity
- uncontrolled diabetes
- autoimmune diseases
COMPLICATIONS OF AUTOGENOUS TISSUE RECONSTRUCTION
In general, complications are rare:
- partial or total flap necrosis due to vascular compromise
- infection – extremely rare
- seroma, more common (2% of cases) at the donor site on the back due to separation between skin and deeper tissues – easily resolved by aspiration
- capsular contracture, a late complication, also relatively rare
It is important to know that reconstruction with the latissimus dorsi flap and implant, like any other reconstruction type, does not influence the risk of tumor recurrence.
Any woman with a reconstructed breast should have annual imaging follow-ups just like the healthy breast.
Also, lymphedema is not worsened in women who already have it.
The numerous advantages of this reconstructive method reflect the improved quality of life for women who have gone through the major trauma of breast cancer. All women regain their main attribute – FEMININITY!
