Ductal Carcinoma in Situ (DCIS)

Breast reconstruction using an LD flap

This operation involves moving a large muscle (latissimus dorsi) and some overlying fat and skin from the back of the body. The flap and its blood supply are tunnelled under the skin just below the armpit. It is then put into position to make a new breast shape, with or without an implant. The operation is referred to as a latissimus dorsi flap, or LD flap. More medical information about an LD flap breast reconstruction can be found on the Macmillan Cancer Support website.
 
Some women said that, after talking to the plastic surgeon and breast care nurse, they decided to have an LD flap reconstruction. A few had immediate reconstruction because they didn’t want to ‘wake up after surgery with no breast’, while others said they didn’t like the idea of having to wear a prosthesis. Several said they preferred an LD flap to a DIEP flap, which uses muscle from the abdomen, because it was a slightly shorter operation. One woman felt rushed into making a decision about immediate breast reconstruction and said she would have liked more time to think about the various options.
One woman said she was unhappy with pictures she’d seen of reconstructed breasts but found it reassuring talking before her surgery to a younger woman who’d had the same operation. Several said they would have liked to speak to other women who’d had breast reconstruction before deciding which sort to opt for. After surgery, one woman met two such women, which she found extremely helpful because they could compare experiences.
Breast reconstruction using muscle, fat and skin from the back, is a major operation and needs a hospital stay of at least several nights. Using a flap from the back generally gives a lower risk of complications than using a pedicled flap from the abdomen, but an implant is often needed. Some women talked about how they felt when they came round after surgery, several saying that, at first, they had a stiff or sore arm and did exercises to keep it mobile. Many said they had support from family when they first came home and were careful not to lift heavy objects or over-exert themselves physically. One woman said a friend of hers was having a similar operation at the same time as her and they supported each other.
A few of the women we spoke with said that they still had pain and discomfort across their arm and other areas of the body several months after surgery. One had minor surgery later to treat this and another was hoping to have some minor surgery.
One woman said she couldn’t have immediate reconstruction because, after her mastectomy, there was a possibility she would need radiotherapy. She had reconstructive surgery six months after her mastectomy and was glad not to have to wear a prosthesis any more.
An LD flap operation leaves scars both from where the skin and muscle flap is taken, and on the reconstructed breast. The scar around the reconstructed breast is oval and the scar on the back usually goes straight across (horizontally), so a bra will generally cover it. Sometimes this scar is more diagonal, which can make it more difficult to cover with a bra but it could be covered with a swimsuit. Women also talked about how they felt about their changed body image.
An LD flap reconstruction generally has few problems and can make a small or moderate size breast very well. However, it cannot always match a very large breast. Some women with large breasts had a breast uplift procedure (mastopexy) or reduction of the other breast at a later time, to get a good match. A few also said they planned to have nipple reconstruction (see Nipple reconstruction).
More experiences of breast reconstruction can be found on the Healthtalkonline Breast Cancer site.

Last reviewed October 2013.

Last updated November 2011.

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