Latissimus dorsi myocutaneous flap

A Latissimus Dorsi Myocutaneous Flap is a form of breast reconstruction which transplants the patient’s own muscle, fat and skin from the middle back to the chest to form a breast mound.

Advantages

This flap is more easily created and contains a robust vascular supply compared to other flaps such as Transverse rectus abdominis musculocutaneous flap or Deep inferior epigastric perforator flap reconstruction.  Therefore is commonly used if a previous flap has failed¹. 

A latissimus dorsi flap also causes less patient morbidity as it does not weaken the abdominal wall.

Disadvantages

A Latissmus Dorsi myocutaneous flap produces a less pleasing aesthetic result when compared to TRAM and DIEP flap reconstructions. Commonly requires an implant to achieve symmetry or a pleasing aesthetic result.

Leaves a large scar in the middle of the back and commonly is complicated by a postoperative seroma.

Causes a temporary 15-20% reduction in shoulder strength².

Radiographic Features

MRI

Rotated and tunnelled Latissmus dorsi muscle  gives a tailed appearance to the reconstruction².

Denuded dermal layer is seen parallel to the skin of the breast.

Complications

• Post operative seroma in donor site. Some report upwards of >95% of patients developing a post operative seroma²³.
• Postoperative Wound infection
• Post operative haematoma
• Wound dehisance
• Flap necrosis
• Chronic back pain

Differential Diagnosis

• DIEP flap
• TRAM Flap