LATISSIMUS DORSI (LD) RECONSTRUCTION FLAP

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1 LATISSIMUS DORSI (LD) RECONSTRUCTION FLAP Information Leaflet Your Health. Our Priority.

2 Page 2 of 6 What is a Latissimus Dorsi Flap Reconstruction? It is an operation performed to recreate the breast shape after you have had a mastectomy. The surgeon uses the muscle and some skin from your back along with an implant to recreate the breast shape. What are the benefits of this type of reconstruction? By using the muscle and skin from your own body this gives the reconstructed breast a more natural shape and feel than an implant alone. Reconstruction with tissue from another area of the body is also suitable for patients who have had radiotherapy which other techniques aren t. What does the operation involve? The operation is performed under general anaesthetic and takes between 4 and 6 hours. If the breast is still there then firstly a mastectomy is performed through an incision around your nipple. If you have previously had a mastectomy then the scar on the chest wall is opened up and space made for the flap. Following this a wound on the back is made so that skin as well as the latissimus dorsi muscle can be dissected and passed through to the front wound. Then the muscle and skin are positioned in place to make the breast shape. Some patients require an implant as part of the procedure whilst others will require a tissue expander, the surgeon will explain what he feels is the most suitable for you. A tissue expander is put in position to allow stretching of the muscle and skin over the next few months. Following the procedure you will have between 2 and 4 drains in place and these may remain in for around 6 days. Are there any alternatives to a Latissimus Dorsi Flap Reconstruction? Yes there are. For some patients they may prefer an implant based reconstruction although this is not suitable for all patients. There are other tissue based reconstructions e.g. DIEP flap reconstruction, please talk to your surgeon or breast care nurse about these if you haven t already done so. Doing nothing is also an option and many women decide not to undergo any form of reconstruction and instead may choose to wear a prosthesis in the bra. For further information about the varying prosthesis please contact the breast care nurses on the number below. Is there an age limit for patients wanting this procedure? No, however it is major surgery and your surgeon will only perform this procedure if it is safe to do so. Are there any risks of this surgery? Yes, as with any operation there are complications such as bleeding, infection, blood clots to the legs and anaesthetic complications. Specific complications of this operation that can occur are:

3 Page 3 of 6 Necrosis of the skin; this is where the skin at the edge of the wound dies and becomes black. In this case sometimes further surgery is needed to remove this skin and in rare cases a skin graft is taken from another area of the body Difference in size and shape to the other breast. Your surgeon will try to make it as similar as possible to the other breast but in some cases further surgery is necessary to alter your other breast Numbness or pain around the armpit; the pain is due to injury or bruising of the small nerves and normally settles in a few weeks. Numbness can last around 6 months Arm weakness; it can take up to a year to gain the full strength back in the arm on the same side of your surgery Infection of the implant; this is rare, however, if it should occur then the implant will need to be removed and not replaced for around 3 or 4 months later, until the breast has settled down Rupture of the implant; although in most cases this will not cause you any harm your surgeon is likely to recommend changing the implant Formation of a capsule around the implant; this is something that if it should happen would happen months or years later, If this was to occur then the implant would need to be removed, the capsule divided or removed and a new implant inserted Can I meet a patient who has already had this done? Yes, if you are looking at proceeding with a Latissimus Dorsi Flap Reconstruction then your breast care nurse can arrange for a patient to come in and chat to you about their experience and in some cases they are happy to show you their result. How long will I be in hospital? We would expect you to go home 5 days after your surgery, if all is well. You will be sent home with full instructions on how to manage your drains at home if necessary. Exercises will be given to you that need to be done and you will also have also have a list of contact numbers should you have a problem when you got home. Will having this surgery delay any other treatment I may need? If it was decided after your surgery that you needed to have chemotherapy, then it may delay this for a few weeks because the recovery time is a little longer for a LD flap than having a mastectomy, but please discuss this with your breast care nurse or surgeon. Will having this surgery increase my chances of getting a recurrence of my cancer? No, there is no evidence that this surgery will increase your risk of recurrence of your cancer

4 Page 4 of 6 What will happen on the day I have my operation? You will come into the ward on the morning of your surgery. You will be settled into the ward and then you will be seen by the anaesthetist and surgeon. The surgeon will need to take some measurements of you and then identify where the cuts into the skin need to be made; he will then mark this on your skin with a pen. You will come down to the operating theatre where you will be met in the reception bay by your anaesthetic nurse. Once you ve been checked in you will be wheeled into the anaesthetic room where you will have your anaesthetic. Following your surgery you will return to the Jasmine ward. You will have drains in the wounds at the front and the back, intravenous (IV) fluids and a PCA (patient controlled analgesia pump) for pain relief. The nursing staff will then continue to do checks on you throughout the night. What should I expect from you? Painkillers - we will prescribe you plenty of painkillers which you should take at regular intervals. Do not hesitate to mention if you are suffering any pain; don t suffer in silence Observations - this involves regular readings of your blood pressure, oxygen levels, pulse, temperature and also regular checks of your new breast and the wound at the back Physiotherapy - you may have seen the physiotherapist prior to your surgery; they will also visit you on the first day after your surgery. They will go through the arm and chest exercises you need to do Blood Clot prevention - A Blood clot in your leg (DVT) is a known risk of surgery therefore you will be given some stockings to wear immediately after your surgery. These are designed to reduce your chance of getting a blood clot (DVT) in your leg. You will also be given a small injection into your tummy on the day after your surgery until the day you are discharged; this injection keeps your blood thin and again helps reduce the chance of you getting a blood clot Discharge - We will expect you to be going home 5 days after your surgery if everything has gone to plan. If any of your drains remain in you will be shown how to manage them and be provided with a leaflet to take home about drain emptying Concerns after discharge - You will be provided with a list of contact details if you should have a problem once you have gone home Follow up - you will need to return to the Bobby Moore clinic on the following Friday morning between 9 and 12noon for a wound check and also if necessary removal of a drain Drainage - once all the drains have been removed you are likely to have a build up of fluid (seroma) which will need draining with a needle and syringe for a while afterwards, particularly from the back wound. We have drop-in clinics twice a week that you can come to for drainage

5 Page 5 of 6 Breast care nursing support - you will have daily visits from your breast care nursing team whilst you are in hospital and full details of how to contact them following discharge What do you expect from me? Pain - inform of us of any pain or discomfort you are getting. If we know about it then we can do something about it. The day following your surgery we will be looking at reducing your IV painkillers and moving onto oral medication Questions - don t be scared of asking questions, that is what we are here for. We want to make your recovery as smooth as possible and therefore keeping you informed is very important to us Day 1 after surgery - We will want you to start mobilising as early as possible. Your risk of blood clot (DVT) and chest infection increases the more you lie in bed so we will want you to get out of bed and sit out in the chair. Also we will be looking at taking all IV fluids down so you will be encouraged to eat and drink as early as possible Physiotherapy - you will be given exercises by the physiotherapist, it is important that you do these in order to assist with a smooth and speedy recovery Blood Clot Prevention - we will expect you to wear some stockings whilst you are in hospital and also for the first few days on returning home to help prevent a blood clot (DVT) How long will it take for me to return to normal activities? Most women return to normal activities within around 6 weeks. For the first 3 weeks we advise no heavy lifting, strenuous housework, vacuuming or ironing. Regular gentle exercise should help you to return to normal activities as soon as possible. We advise no driving for at least 3 weeks. Before driving for the first time you should contact your insurance company to check you will be covered. Contact us If you have any further question with regards to this information leaflet you can contact the Breast Care Nurses on /4752. If you require any specific assistance please do not hesitate to contact inform the breast care nurses. For those who require a sighted guide these are based in the main reception

6 Page 6 of 6 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number SUR98 Publication date May 2015 Review date May 2017 Department Bobby Moore Unit Location Stepping Hill Hospital