Breast reconstruction – lattisimus dorsi and implant

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As an alternative to TRAM flap for breast reconstruction, LD myocutaneus flap with implant was used satisfactorily

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Breast reconstruction – lattisimus dorsi and implant

  1. 1. Breast reconstruction –Lattisimus Dorsi and Implant Shailesh Nisal Ramya Nisal Sparsh Clinics Nagpur India www.sparshclinics.com
  2. 2. 50 yr old, DCIS high grade central quadrant tumor with few subcentimeter axillary nodes
  3. 3. Plan - MRM with reconstruction by LD + Implant
  4. 4. MRM Defect, turned for LD harvest
  5. 5. Lat Dorsi Myocutaneus flap raised, ready to be tunnelled
  6. 6. Closure of back, flap on chest
  7. 7. Implant in position after closure and the next day
  8. 8. Day 4Flap doing wellProjection adequateInframammary creasein correct position
  9. 9. Week 2 – Oedema reducing, Flap and implant doing well
  10. 10. DELAYED BREASTRECONSTRUCTION
  11. 11. Mastectomy for Cystosarcoma Phylloides 3 yrs ago
  12. 12. Planning…. Marking for Lat Dorsi and skinSize of implant paddle
  13. 13. Landmarks in standing position
  14. 14. Harvest of Latissimus Dorsi Myocutaneus Flap
  15. 15. Thoracodorsal Pedicle dissected and skeletonized
  16. 16. Flap tunneled to chest, implant readied for insertion
  17. 17. Implant placed, covered with muscle from all sides, closure
  18. 18. Supported Bra
  19. 19. Good volume, IMF in correct position. Absent nipple-areola, no ptosis.
  20. 20. Projection of breast equal, donor scar acceptable
  21. 21. Massage inward and upward for implant comfort
  22. 22. Before and after
  23. 23. Thanks …. Questions? Shailesh nisal Ramya nisal sparsh clinics nagpur india www.sparshclinics.com

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