Latissimus dorsi myocutaneous flap

A latissimus dorsi myocutaneous flap is a form of breast reconstruction that transplants the patient’s own latissimus dorsi 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 (TRAM) flap or deep inferior epigastric perforator (DIEP) flap reconstruction. Therefore, it is commonly used if a previous flap has failed ¹. 

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

Disadvantages

A latissimus dorsi myocutaneous flap produces a less pleasing aesthetic result when compared to transverse rectus abdominis musculocutaneous and deep inferior epigastric perforator flap reconstructions. It commonly requires an implant to achieve symmetry or a pleasing aesthetic result.

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

It causes a temporary 15-20% reduction in shoulder strength ².

Radiographic features

MRI

Rotated and tunnelled latissimus dorsi muscle gives a tailed appearance to the reconstruction ².

The denuded dermal layer is seen parallel to the skin of the breast.

Complications

• postoperative seroma inat donor site. Some report upwards of >95% of patients developing a postoperative seroma ³.
• postoperative wound infection
• postoperative haematoma
• wound dehiscence
• flap necrosis
• chronic back pain

Differential Diagnosis

• DIEP (deep inferior epigastric perforator) flap
• TRAM (transverse rectus abdominis musculocutaneous) flap