LD muscle is a large fan like muscle starting behind the armpit and spreading on the back. This flap uses the muscle along with an oval/ elliptical island of skin and underlying fat, which is then rotated via the armpit into the breast defect to rebuild the breast. The blood vessels are moved along with the muscle, so the flap retains its original blood supply. It leaves a scar on the back, which can be horizontal (hidden very well under clothes) or slanting (slightly more visible)
What to expect in surgery
The surgery is performed under complete anesthesia (GA), and an elliptical incision is made on the same side back, just below the shoulder blade bone. The skin, underlying ellipse of fat and the complete muscle is separated from surrounding structure while keeping the artery and vein safe. The muscle thins out near armpit where a tunnel is created to rotate the flap into breast. The flap is then moulded into the shape of the breast and placed. The procedure takes 3-4 hours. The expected stay in hospital is 3-4 days after surgery. Usually ICU stay is not needed.
The expected stay in hospital is 3-4 days after surgery. Usually ICU stay is not needed. Food will be allowed on same or next day. Patient is made to ambulate and physiotherapy is started by next day of surgery.
- Provides a good match to the breast skin
- Can be used when there is not enough fat in lower abdomen
- Can be done after a failed DIEP flap
- For those who don’t prefer bigger micro-vascular reconstructive surgery
- Suitable for small to medium size breast.
- Often requires an implant for higher volumes
- Muscle can decrease in size with time
- Scar on the back
- Fluid collection (seroma) at back