This procedure uses the back muscle, called Latissimus Dorsi, to create the breast mound. It can reconstruct a breast on its own, or can be used in combination with a tissue expander and/or implant. The Latissimus Dorsi muscle is moved from the back to the chest to cover the tissue expander and/or implant.
This procedure is commonly offered to patients that have had a previous mastectomy and radiation to their chest and/or are not candidates for
a DIEP procedure due to being too thin and not having enough tissue in their stomach area or are unable to tolerate such a long procedure.
The incision on the back may be horizontal or vertical. It can be hidden by most types of clothing and/or behind the bra line.
The tissue expander is filled with normal saline (salt water) to stretch the muscle to create a pocket for the permanent implant. This may start as early as 2 weeks after your operation and once incisions heal. The expansion process will take place every 1 to 2 weeks in clinic.
Using a needle and syringe, normal saline is injected into the tissue expander to stretch the skin and muscle to create space for the permanent implant.
After the last expansion, there is a healing phase of approximately 3 months before the tissue expander is removed and a permanent implant is put in place.
Permanent implant based breast reconstruction
Planning for your operation
If you were given a prescription and asked by your plastic surgeon to wash your skin with antibiotic soap, please wash your chest area (from the collar bone down to your belly button) and your back every day starting 7 days before your operation.
Your surgeon will discuss with you if you need to purchase a supportive surgical bra. You will be asked to bring this with you to your operation.
How long will I need to stay in the hospital?
You can expect to be discharged 1 to 2 days after your Latissimus Dorsi Flap operation or the same day if you are having your tissue expander exchanged for a permanent implant.
Average recovery for a Latissimus Dorsi Flap operation is 3 to 4 weeks. You will be unable to do any heavy lifting of more than 10 pounds for 4 to 6 weeks after your operation. As well, you will be unable to lift anything over 10 pounds for the first 24 hours after your tissue expander inflation.
The recovery for tissue expander exchange to permanent implant insertion is 2 to 3 weeks. You will not be able to do any heavy lifting of more than 10 pounds for 4 to 6 weeks after your operation.
Stop smoking before your surgery
You will have an appointment at the Pre-Admission Clinic
within 2 weeks before your surgery. This visit is very important to assess your health and help you prepare for your operation and recovery. Depending on your needs, this visit may take
from 2 to 5 hours.
On the day of your Pre-Admission visit, take your medications and eat as usual, unless you were given other instructions.
Pre-Admission Clinic
Toronto General Hospital
Eaton Building – Ground Floor, Room 400
TGH Maps & Directions
Phone: 416 340 3529
Fax: 416 340 5191
- Your health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID, such as a driver's license or passport.
- Your health card and any other insurance cards. You will need the policy number of your extended health insurance, if you have any.
- Your spouse/partner, a trusted friend or a family member to offer you support and be a second set of ears.
- All the medications you take in their original containers. This includes prescription medications, over-the-counter medicines, vitamins, supplements and herbal or natural products.
- A copy of your power of attorney for personal care and/or advanced directives.
- A list of any questions that you may have about the operation and recovery.
- The name or phone number of your pharmacy, as well as any medical specialists that you have seen in the past 3 years. If you have had a cardiac stress test, echocardiogram and/or a pulmonary function test in the past 3 years, it would be helpful to bring a copy of the final report with you to this appointment.
- You will have blood tests and routine skin swabs. The swabs are taken from your nose and other areas of your body to check for germs that can cause infections.
- You may also need an
ECG to check your heart and a chest
x-ray to check your lungs.
- You will meet many health care providers during your pre-admission visit. Please feel free to ask them any questions that you may have:
A pre-admission nurse will review your health history and give you information to prepare you for your operation, including directions for
cleaning your skin, eating before operation, taking your medications, and pain management.
A pharmacist will review your medications.
- Depending on your needs, you may also meet:
An anesthetist who will review your health history, discuss your anesthetic plan and pain relief after operation.
A member of the medicine team, if you have other complex health problems.
A Clinical Nurse Specialist (CNS), or Nursing Coordinator, who specializes in the care of patients having your specific operation. They will review any preparation that is required before your operation, plans for discharge home after operation and specific instructions regarding your recovery.
Stop eating food by midnight on the night before your operation. Your stomach needs to be empty.
-
STOP eating food at midnight on the night before your operation.
- You may drink clear fluids up to 5 hours before your operation.
- Examples of clear fluids you can drink:
- Apple juice
- Beef or chicken broth (no noodles or vegetables)
- Orange juice (without pulp)
- Grape juice
- Jell-O or popsicles
- Cranberry juice
- Pop (such as ginger ale, 7-Up, Coke)
- Lemonade
- Water
- Coffee or Tea (no milk)
TIP: It is safest to stop eating and drinking the midnight before your operation.
Arrive
2 hours before your scheduled operation time:
Surgical Admission Unit (SAU)
Toronto General Hospital
Peter Munk Building – 2nd Floor
TGH Maps & Directions
All hospital entrances are open by 6 am. However, Elizabeth St. and University Ave. are easiest to access.
- We will prepare you for the operation.
- If you did not see the anesthetist in the
Pre-Admission Clinic, you will meet them before your operation.
- We will mark the area where we are doing your operation.
- We will give you a small needle with Heparin, a medication to help lower the chance of developing blood clots.
- We will give you an intravenous (IV) drip. This is a small needle that we put in a vein in your arm. We use it to give you one or all of the following: fluids, antibiotics or pain medications.
On this page, you can read all about what to expect during your hospital stay. Or, just click on one of the links below, to get the answer you want right now.
- You will wake up in the
Post Anesthesia Care Unit (PACU) and stay there for 1 to 2 hours.
- Once you are ready to leave the PACU, you will be moved to the Consolidated Short-Stay Unit (CSSU).
- You will be attached to some or all of these tubes:
- IV – We usually take the IV out as soon as you can tolerate an oral diet.
- Oxygen – Oxygen helps you breathe. This will be delivered through nasal prongs.
- Jackson Pratt drain(s) (JP) – are placed at your surgical site to drain fluid.
- The nurses will give you a medication through the IV (antibiotics, anti-nausea).
- You will have dressings on your surgical incisions.
- Initially after your operation you may feel drowsy and tired.
- You may experience some pain at your surgical sites and/or nausea. We will manage your symptoms with medications.
- You may feel some tightness in your chest.
- After a breast reconstruction operation, it is normal to feel stiff in your back, chest, shoulders and arms.
- It is important to do range of motion exercises post-operatively to encourage circulation.
- At home, you will be able to do your light activities of daily living (such as walking, toileting, getting dressed, personal hygiene).
- We will send a referral to the Local Health Integration Network (LHIN) to arrange for a nurse within your community to help you to take care of the drain(s).
You can expect to be discharged 1 to 2 days after your Latissimus Dorsi Flap operation or the same day if you are having your tissue expander exchanged for a permanent implant. Your health care team will talk to you about your stay once you're out of the PACU.
Please monitor the surgical sites for signs of infection (increasing redness, pain, fever). If you are concerned about the surgical site, please contact your surgeon's office or return to the emergency department at the hospital where your operation was performed.
- There are no dietary restrictions; you may eat what you can tolerate.
- If you have a clear dressing on your surgical site, you will be asked to leave this on until your follow-up appointment.
- If you have a fabric type of dressing, this can be removed 48 hours after your operation. Leave the Steri-Strips (paper tapes) along your incision until your follow-up appointment.
- Avoid heavy lifting of more than 10 pounds (this includes pushing heavy objects).
- You will be given a prescription upon discharge from hospital; please take your medications as directed.
- If you were given a prescription for antibiotics, please take them until your drains have been removed.
-
DO NOT drive when you are still taking pain medications.
- You may start driving once you are able to check your blind spot safely and you must feel comfortable to make a sudden jerky movement in case of an emergency.
Go to your nearest emergency department if you see these signs of infection:
- Your temperature goes higher than 38°C (100°F) and lasts longer than 24 hours.
- If you feel chills.
- Bright red, hot and swollen incisions or skin.
- White fluid or pus or pus that smells bad.
The Nurse Coordinator is your first place to call for post-operative questions:
Agnes Wisniewski RN, BScN, MN
Phone: 416 340 4800 ext. 5161
You can also
call your surgeon's office for more information.
If you have concerns regarding your breast reconstruction, please call your surgeon's office or go to the emergency department at the hospital where you had your operation.
Before you leave the hospital you will be reminded to call your surgeon's office to schedule a follow-up appointment:
When
About 2 weeks after the operation.
Where
There are two clinics associated with the Breast Reconstruction Program. We will tell you which clinic to go to when you call your surgeon's office to schedule an appointment.
Princess Margaret Cancer Centre |
Maps & Directions
2nd Floor, M. Lau Breast Centre.
Toronto General Hospital |
Maps & Directions
7th Floor, Plastics Clinic
What to Expect
Your surgeon will assess your surgical sites for their healing progress and speak to you about your recovery.
If you had a tissue expander inserted, you most likely will have your first inflation at this clinic visit.
Your surgeon will let you know when you should return for a second follow-up during this appointment. You will be required to call the office to schedule this.
What to Bring
You will need to bring your health card to your appointment.
