Latissimus Musculocutaneous Flap

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APRIL 2015 | The Surgical Technologist | 165
P O S T - O P E R A T I V E C A R E
The patient will spend as many as three days in the hospi-
tal to ensure adequate pain management, flap health and
to monitor drainage. The three drains that are placed are
removed when drainage volumes decline, typically at day 7
to 14 post op. Patients may shower after the breast drain is
removed, typically two to seven days post op and a regular
diet can be resumed immediately. Patients are cautioned to
limit pulling, pushing and reaching with the affected arm.
C O M P L I C A T I O N S
In general, autologous breast reconstruction is more inva-
sive and time intensive than a mastectomy or implant
reconstruction. Flap procedures result in larger and multi-
ple incisions that take longer to heal and may require a lon-
ger hospital stay. Post-operative complications can include
seroma, infection, wound dehiscence, asymmetrical persis-
tence, hematoma, implant rejection and necrosis. Complica-
tions are more readily seen in patients who are obese or tobac-
co smokers. Some studies have shown that complications in
the reconstructed breast were more frequent in the irradiated
patients (39%) than in the nonirradiated patients (25%).4
R E S T O R I N G F U N C T I O N
Following reduction surgery, many women are able to
return to active lifestyles following a six-week hiatus from
strenuous activities. These activities can include, but are
not limited to, running, biking, climbing, cleaning, sitting
straight and traveling. The latissimus dorsi muscle is con-
sidered expendable because no significant loss of adduc-
tion or rotation of the arm occurs if the other muscles of
the shoulder girdle are intact. In patients who use crutches
or are wheelchair bound, it is suggested that they consider
other options before sacrificing the latissimus dorsi muscle.6
For those who are affected by cancer and have elected
to remove their breast tissue prophylactically due to family
history or tested positive for the BRCA gene, the support
of their medical team and friends and family can make the
process more comfortable not only for the acceptance of
the physical transformation but for the mental transforma-
tion as well. The unknown of what one will look like after
reconstruction can be a heavy burden on women and their
partners. Many books have been published showing real
women in various stages of reconstruction. These books can
help couples and individuals to understand their bodies will
have sensuality after surgery and to provide comfort in the
journey they are about to embark on.
Finding natural breasts that are identical is rare,
as nature often does not produce perfect symmetry.
Reconstructive surgery provides an opportunity to cre-
ate more symmetrical breast since surgeons can essen-
tially start from a blank canvas. An autologous tissue
reconstruction, such as a latissimus musculocutaneous
flap, is an extensive and multi-staged process that can
provide patients seeking breast reconstruction a more
aesthetically pleasing outcome. When a patient elects to
have only one side reconstructed, it may be advised to
have an augmentation, mastopexy or reduction on the
contralateral side to ensure symmetry. There are a grow-
ing number of options for breast cancer patients and
educating oneself on the best option for their specific
diagnosis is the first step.
A B O U T T H E A U T H O R
Leah-Marie Guill became a surgical
technologist after working as a vet-
erinary assistant and falling in love
with the surgical procedures and
advancements she observed. She is
a Certified Surgical Technologist,
and earned her associate degree in surgical technology
from the College of Western Idaho and a bachelor of
science from the University of Idaho in physical educa-
tion with an emphasis in biology. She currently works as
a private assistant for a plastic surgeon in Boise, Idaho,
and is the vice president of the Idaho State Assembly of
the Association of Surgical Technologists.
R E F E R E N C E S
1. American Cancer Society. Breast Cancer Facts & Figures 2011-2012.
Atlanta: American Cancer Society, Inc.
2. Girling, Hanby, Mills, Radiation and other pathological changes
in breast tissue after conservation treatment for carcinoma. J Clin
Pathol. 1990 February; 43(2): 152–156.
3. Guill, L Breast Reduction Surgery to Treat Macromastia. The Surg
Technologist,October 2012.
4. Kroll SS, Schusterman MA, Reece GP, et al. Breast reconstruction
with musculocutaneous flaps in previously irradiated patients. Plast
Reconstr Surg.1994;93:460–71.
5. Latissimus Dorsi Muscle Transplantation. Microsurgery Atlas, Tech-
niques and Principles.
6. Little, S. Latissimus Myocutaneous Flap. Medscape. November 2013.
7. Perdikid G, Koonce S, Collis G, et al. Latissimus Dorsi Musculocuta-
neous Flap for Breast Reconstruction: Bad Rap or Good Flap? Eplasty.
2011; 11: e39.
8. Richardson, M. Muscle Atlas of the Extremities. Bare Bone Books,
May 2011.
9. Spear SL, Boehmler JH, Taylor NS, Prada C. The role of the latissi-
mus dorsi flap in reconstruction of the irradiated breast. Plast Recon-
str Surg. 2007;119(1):1–9.