19361 Breast reconstruction; with latissimus dorsi flap

Name of the Procedure:

Breast Reconstruction with Latissimus Dorsi Flap

• Common Name: Latissimus Dorsi Flap Surgery
• Technical Term: Latissimus Dorsi Myocutaneous Flap Reconstruction

Summary

Breast reconstruction with a latissimus dorsi flap involves using muscle, fat, and skin from the patient's upper back to reconstruct the breast. This procedure is often used to restore the breast's shape and size following mastectomy (breast removal surgery due to cancer or other conditions).

Purpose

• Medical Condition: Post-mastectomy breast reconstruction
• Goals: To recreate a natural-looking breast mound, improve symmetry, and enhance psychological well-being after mastectomy.

Indications

• Women who have undergone mastectomy and desire breast reconstruction.
• Patients not suitable for implant-based reconstruction due to previous radiation therapy or lack of sufficient tissue.
• Individuals seeking autologous (using the patient's own tissue) reconstruction options.

Preparation

• Instructions: Possible fasting 8 hours before surgery, ceasing certain medications like blood thinners.
• Tests: Preoperative assessments such as blood tests, imaging studies, and possibly a cardiac evaluation.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: An incision is made on the back to access the latissimus dorsi muscle.
3. Flap Creation: A portion of the latissimus dorsi muscle, along with overlying fat and skin, is carefully lifted and tunneled to the chest.
4. Reconstruction: The flap is shaped to create the new breast mound and secured in place.
5. Closure: Incisions on the back and chest are closed with sutures.

Tools and Equipment: Surgical instruments, cautery tools, surgical drains, suture materials.

Duration

The entire procedure typically takes 3 to 6 hours.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Lead Surgeon: Specialized in plastic and reconstructive surgery.
• Surgical Team: Assisting surgeons, scrub nurses, and surgical technologists.
• Anesthesiologist: To administer anesthesia and monitor the patient.

Risks and Complications

• Common Risks: Infection, bleeding, scarring.
• Rare Risks: Flap failure (loss of tissue), muscle weakness, asymmetry.
• Complications Management: Immediate medical attention for flap health, antibiotics for infections, and revision surgeries if necessary.

Benefits

• Expected Benefits: Restores breast shape, improves body image, and enhances quality of life.
• Realization Time: Visible results immediately, with final outcomes apparent after healing (several weeks to months).

Recovery

• Post-Procedure Care: Hospital stay of 2 to 5 days, drainage tube management, pain medication.
• Recovery Time: 4 to 6 weeks for initial recovery, with a return to normal activities in 6 to 8 weeks.
• Follow-Up: Regular appointments to monitor healing, manage scars, and optimize contour.

Alternatives

• Other Options: Implant-based reconstruction, DIEP flap, TRAM flap.
• Pros and Cons: Implant-based options may have shorter surgery times; however, they might not be suitable after radiation. DIEP and TRAM flaps use abdominal tissue, which can result in a longer recovery.

Patient Experience

• During Procedure: Patient will be under general anesthesia and won't feel anything.
• After Procedure: Some pain and discomfort managed with medication, soreness at donor and recipient sites, possible swelling and bruising.
• Pain Management: Pain relief medications, position adjustments for comfort, and support garments post-surgery.