Highlights
- A reliable technique, even in patients who have undergone radiotherapy
- Can be combined with fat grafting (lipofilling) or an implant for optimal volume
- Produces a discreet scar hidden beneath the bra strap
- Covered by French health insurance
Overview: What is Back Flap Reconstruction?
A mastectomy (also called a mammectomy) involves the complete removal of the mammary gland, a portion of the overlying skin, and the areola-nipple complex. In some cases of breast cancer, this remains a necessary step.
Breast reconstruction using a latissimus dorsi (LD) flap utilizes a strip of skin and muscle from the upper back, transferred to the chest to recreate breast volume. This reconstruction is commonly combined with:
- A breast implant for added volume
- Or fat grafting (lipofilling) for a more natural contour
This technique offers predictable results, especially for patients who have undergone radiation therapy, which may limit other reconstruction options.
Principles of Latissimus Dorsi Flap Reconstruction
The latissimus dorsi is a thin, broad muscle on the back that is non-essential for daily function, making it an ideal donor site. The reconstruction process involves:
- Reusing the mastectomy scar as an access point (this scar can sometimes be revised but not removed)
- Harvesting a spindle-shaped segment of skin and muscle from the back
- Transposing this flap to the chest to create the breast mound
In most cases, an implant is placed under the muscle and skin flap to provide sufficient volume.
Alternatively, in select cases, lipofilling (using fat from the abdomen or thighs) may be used instead of an implant.
Procedure Details
- Anesthesia: General anesthesia is required. A pre-anesthesia consultation must be completed at least 48 hours before surgery.
- Surgical time: 2 to 3 hours
- Hospitalization: 3 to 5 days
- Pre-op instructions:
- Stop smoking at least one month before and after surgery to avoid complications
- Avoid Aspirin or anti-inflammatory medications for 10 days prior
At the end of surgery, a bra-shaped dressing is applied to support healing. The donor site scar is horizontal and typically concealed under the bra line.
Post-Operative Recovery and Management
- Pain management is tailored and provided preventively
- Monitoring of the flap’s vitality (color, temperature, capillary refill) is done regularly
- Physical therapy is prescribed to help regain full mobility of the shoulder
- A 15-day work stoppage is typically needed
Once the breast mound has stabilized, symmetrization of the opposite breast and reconstruction of the nipple-areola complex are performed as follow-up procedures.
Costs and Reimbursement
- The procedure is covered by French Social Security
- Additional surgical fees range from €3,500 to €4,500
These fees may be partially or fully covered by complementary health insurance, depending on your policy