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Autologous Tissue Reconstruction in Hull, York, Grimsby, Lincoln & London


This is when your own body only is used without an implant. They often give excellent long term results but tend to involve more major initial surgery. Surgery involves taking tissue from the tummy, upper thigh, buttock or back. Complications can occur with both the reconstruction and the donor site. Advantages are the greater similarity in the texture, shape and behavior between the reconstructed breast and the opposite side. The reconstructed breast gains, looses weight and changes shape together over time with the normal side (unlike implants) with lower rate of revision.

Back Muscle: Latissimus dorsi (LD) flap


This is a surgical technique that involves transferring the back muscle (latissimus dorsi) with the surrounding fat and overlying skin into the mastectomy site. Removal of the muscle does not usually affect an individual in most day to day activities, though some patients may notice slight shoulder weakness and stiffness.

The two variations of this technique are:

  1. The more common Extended LD flap involves additional recruitment of surrounding fat around the muscle +/- lipofilling to increase the size later.
  2. Less commonly, the muscle is augmented with an implant (LD + implant) at the same time to build up volume.

Outcome: Overall results with ELD reconstruction are very good but there are some limitations and risks. Fluid collection on the back (seroma) occurs in 30-40% of patients and may necessitate serial needle aspirations. The overall complication rate is approximately 10-12%, mostly relatively minor in nature. They include:

  • Scars heal well but can become stretched and lumpy (hypertrophic).
  • Infection can occur which may require antibiotics.
  • Bleeding straight after surgery may necessitate a return to theatre.
  • Wound breakdown and delayed healing occasionally occur.
  • You can get a dish like deformity in the back, due to the muscle transfer.
  • Excess tissue (dog ear) on the back or chest scar may require revision.
  • Lumpiness in the armpit as the flap passes from the behind to before.
  • Muscle often twitches on the reconstructed breast on shoulder movement.
  • Stiffness of shoulder can result, and you will be advised on exercises.
  • Flap failure is uncommon (<1%) but may necessitate removal if it occurs.
  • Blood clots in the calf and lungs can occur after any major operation.
  • Final appearance is less predictable if you have radiotherapy afterwards.
  • Anaesthetic risk although rare will be discussed with your Anaesthetist.

Limitations: Some degree of asymmetry is always present before and after reconstruction, hence lipofilling and contralateral breast surgery may be necessary to improve this. Changes naturally occur with age and weight alteration and a specific bra cup size cannot be guaranteed through surgery.

Procedure (ELD flap)

PURPOSE
Breast Restoration

PRE-OP
Smoking cessation

OP TIME
4-5 hours

ANAESTHESIA
General

ADMISSION
2-3 days

RECOVERY
4-6 weeks

POST-OP
Dressings; 7-12 days,
Clinic review; 2-4 weeks