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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
Shailesh Nisal
Ramya Nisal
Sparsh Clinics Nagpur India
www.sparshclinics.com
50 yr old, DCIS high grade central quadrant tumor with few
subcentimeter axillary nodes
Plan - MRM with reconstruction by LD + Implant
MRM Defect, turned for LD harvest
Lat Dorsi Myocutaneus flap raised, ready to be tunnelled
Closure of back, flap on chest
Implant in position after closure and the next day
Day 4
Flap doing well
Projection adequate
Inframammary crease in correct position
Week 2 – Oedema reducing, Flap and implant doing well
DELAYED BREAST RECONSTRUCTION
Mastectomy for CystosarcomaPhylloides 3 yrs ago
Planning….
Size of implantMarking for Lat Dorsi and skin paddle
Landmarks in standing position
Harvest of Latissimus DorsiMyocutaneus Flap
Thoracodorsal Pedicle dissected and skeletonized
Flap tunneled to chest, implant readied for insertion
Implant placed, covered with muscle from all sides, closure
Supported Bra
Good volume, IMF in correct position.Absent nipple-areola, no ptosis.
Projection of breast equal, donor scar acceptable
Massage inward and upward for implant comfort
Before and after
Shailesh nisalRamya nisal
sparsh clinics nagpur indiawww.sparshclinics.com
Thanks …. Questions?