The latissimus dorsi is a large quadrilateral muscle on the back.
The extended latissimus dorsi flap (ELD) involves harvesting the fat surrounding the muscle and gives more volume than the standard flap, which uses the muscle alone.
The standard flap is suitable to fill a partial breast defect following a wide local excision but when it is used as to reconstruct the breast following mastectomy, an implant is always required beneath the flap to give sufficient volume. The extended flap can be used without an implant to reconstruct a small breast (around a B cup). For a larger breast reconstruction, an implant may be needed, or alternatively, fat injections can be performed at a later stage to increase the size of the reconstructed breast.
The benefit of using your own tissue rather than an implant is that the look and feel of the breast is more natural than with an implant alone and there are none of the limitations and complications associated with implant surgery. The operation is always done under a general anaesthetic and the average length of hospital stay is 5 days.
Breast Reconstruction - Breast Implants Limitations & Complications
Muscle twitching – this occasional occurs and is due to the fact that the nerve to the latissimus dorsi muscle may be left intact when raising the flap. Rarely, a second operation is required to go back and divide the nerve.
What is the difference between a latissimus dorsi flap and an extended latissimus dorsi flap?A latissimus dorsi flap (LD flap) is a muscle flap taken from the back. The traditional LD flap is used to drape over an implant when doing a breast reconstruction and the flap itself does not carry much volume and so an implant is always needed. An extended latissimus dorsi flap (ELD) involves harvesting extra fat from the back when raising the muscle and this carries more volume with it. This means that it is possible to reconstruct a smaller breast with an ELD flap alone and no implant, or if an implant is used, then there is more tissue to cover it.
An ELD flap is more technically demanding than an LD flap and there are more potential complications with the donor site on the back, but in my view it is superior to the LD flap and so I almost always use an ELD flap for breast reconstruction. The only time I use an LD flap is if I were resurfacing the chest wall for an advanced cancer and so I would be more interested in simply obtaining cover for the chest rather than providing volume to recreate a breast.