Breast Reconstruction by Latissimus Flap with Implant Cases

This young woman underwent bilateral mastectomy and immediate reconstruction using bilateral latissimus flaps with implants.  Decision making regarding final size outcome comes from the patients’ desire and the need to camouflage successfully the potential mastectomy defect.

In this case the patient desired to increase her breast size and her reconstruction brought her from an A-cup before to a C-cup after.

Outstanding aesthetics of breast for a woman who underwent double mastectomy.

Top row of first photo shows her before mastectomies.  Bottom row shows her after bilateral latissimus flap with implants (silicone gel), bilateral nipple and areola reconstruction and pigmentation.  A beautiful shape to her breasts after total reconstruction.

Second set of photos highlight the minimal backs scars.

This complex case depicts a patient who presented having had previous breast cancer of the left breast treated by lumpectomy and radiation with resulting deformity from radiation of the left breast.  She had recently been diagnosed with a new right breast cancer.

She underwent bilateral mastectomy with reconstruction using bilateral latissimus flaps and implants, and later nipple and areola reconstruction.

An outstanding cosmetic result after double mastectomy.

 

Breast cancer affects the youngest of women.  This woman was in her 20’s when diagnosed.  Determined to beat cancer and preserve her body she elected to do bilateral mastectomies and bilateral latissimus flap with implants (from the back) to rebuild her breast.

First set of photos show her before total mastectomies and then after reconstruction was complete (except for pigmentation of the nipple and areola that I created).

Second photo: A truly beautiful aesthetic breast she obtained from total breast reconstruction.

Third photo highlights the minimal back scarring from the donor area

This is a very complex case.  The patient had previously undergone left mastectomy without reconstruction.  Years later she was found to have a right breast cancer requiring a mastectomy.  She elected to undergo bilateral reconstruction.  Using latissimus flaps with implants she is shown fully reconstructed with the newly created nipple (scar will fade over time).  A miraculous outcome.

A particularly difficult challenge facing a plastic surgeon is when a patient presents with breast cancer (necessitating mastectomy) and profound ptosis (breast sag).

Bilateral latissimus flaps and implants allow for aggressive skin shape change and improved overall breast shape. her post-op views (bottom row) show patient shortly after tattoo pigment added into reconstructed nipples. Interestingly, patient was quite pleased with the back lift she also obtained in the donor area-remember scars fade over time. (second set of photos).

A very challenging case:

Top Row: Patient presented with biopsy proven breast cancer of the right breast and benign biopsy of the left breast that was done elsewhere and healed poorly.

Bottom Row: her reconstruction after right mastectomy included latissimus flap with implant, nipple reconstruction and eventually correction of left breast disfigurement by breast lift with implant. Post-op views bottom row.

Critical in post mastectomy reconstruction is camouflage of potential upper pole deformities, successfully achieved here. (mastectomy patients who view these photos can appreciate what I am saying).

A very nice final outcome for this very athletic, multisport woman.

This case demonstrates how effectively latissimus flap surgery (together with implants) can hep to obtain very cosmetic outcomes in post mastectomy breast reconstruction.

This patient had biopsy scars which were relatively far from the nipple complex and the skin requirements for cancer removal in her case dictated (even in modified skin sparing mastectomy) that a flap be used.

Bottom Photos (post-op): Bilateral mastectomy and bilateral reconstruction with latissimus flap and implant. Note how well scars have faded and how natural the nipple reconstruction appears.

Decision making for the management of either breast cancer or BRCA gene positively includes methods of reconstruction which are individualized for each patient. Flap surgeries help create a breast fully and immediately. Here we see a young woman (who chose bilateral mastectomy and bilateral latissimus flap with silicone gel implants) shortly after her nipple and areola reconstruction was healed. Pigmentation is pending. Skin sparing mastectomy has allowed for less visible scarring. An outstanding aesthetic outcome.

This woman presented having had attempts elsewhere at breast reconstruction after right mastectomy for breast cancer (top views). She had an implant reconstruction on the right and a breast lift on the left already done when I initially saw her. Her right side reconstruction was without shape, had profound hollowness and rippling (top right view) and was not a match to the left, either by volume, position or shape. The left side was poorly shaped and the nipple was too high (top left view).

I removed the right side implant and scar tissue, performed a latissimus flap with implant, created a new nipple, re-lifted the left breast, and added an implant on the left side to create balance, symmetry, and aesthetic shape. In the post op views (bottom) the left breast now has a properly positioned nipple, balanced volume, and improved shape. The right reconstruction matches well, has a nice natural shape, and the hollowness (upper pole) was corrected with fat grafting (compare the two right photos; view of the patients breast before and after). An outstanding transformation.

Shown prior to nipple reconstruction this patient underwent bilateral mastectomy (markings shown for mastectomy incisions dictated by mastectomy surgeon) and bilateral latissimus flap with implant reconstruction.  A natural and soft reconstruction.