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.
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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 at 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
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