Breast reconstruction surgery can be an incredibly emotional process. When you’ve had a mastectomy, it’s natural to be afraid of losing your identity or to worry that the surgery will leave you with scars that are too visible.

But breast reconstruction surgery doesn’t have to be scary—and it doesn’t mean you’re giving up your identity. In fact, if you choose the right surgeon and the right path for your recovery, breast reconstruction can actually help you feel more like yourself than ever before. In this article we will consider reconstruction using back tissue and exercises after breast reconstruction using muscle. Why you need exercise after reconstruction surgery. Latissimus Dorsi Flap Breast Reconstruction Problems Years Later and Latissimus Dorsi Flap Reconstruction Technique .

Reconstruction Using Back Tissue

Latissimus Dorsi Myocutaneous (LD) Flap

Skin Paddle

Latissimus Dorsi muscle with skin paddle

Latissimus Dorsi muscle with implant underneath

The location of the incision on your back will depend on the amount of skin needed to replace the skin removed during the mastectomy. Often, the incision can be placed so that your bra will hide the scar. The back tissue that is rotated to the chest will result in a bulky area underneath the armpit. This will decrease over time but may never disappear.

Often, an additional surgery is necessary to replace the tissue expander that is placed under the LD flap for a permanent silicone or saline implant. The LD flap may also be used after breast conservation surgery to fill in the misshapen area that can result after removal of breast tissue. Patients generally have no major long-term problems from the LD flap, and can resume activities of daily living and exercise just as before the surgery.

Advantages of LD flap reconstruction:

• Decreased surgery and recovery time
• Better coverage over the implant
• One-time surgery, if the implant placed immediately
• Good option for thin patients who have had radiation therapy

Disadvantages of LD flap reconstruction:

• A breast implant is usually required for the desired projection and size
• May have complications in the back where the tissue was taken from
• Muscle weakness in the back can affect rock climbers, swimmers and tennis players

Exercises after breast reconstruction using muscle

It is important to build up exercises gradually after surgery. Always check with your doctor or specialist nurse before doing these exercises. They may want you to do other exercises or use slightly different time scales.

Reconstruction using the tissue from your back

In this procedure, your surgeon takes the muscle called the latissimus dorsi from your back and tunnels it under the skin. They move it below your armpit to the front of your body to make a new breast shape. They may also take some skin and fat with the muscle. The surgeon uses the whole muscle. They remove it from where it attaches to your lower back, but leave it attached to your upper arm where its blood supply is. 

The latissimus dorsi muscle helps to bring your arm into your side and backwards. For example, you use it when lifting something down off a high shelf, or pulling something towards you. You also use the muscle when you push down to raise your body up, for example when you push yourself out of the bath or a chair.

Other muscles can also do some of the things that the latissimus dorsi muscle does. So after this type of surgery you will still be able to move your arm normally. But you might find there are certain specific activities that you don’t have quite the same strength for on the side of the surgery. This will depend on your lifestyle and any hobbies or sports.

Why you need exercise after reconstruction surgery

The aim of exercising after reconstructive surgery is to help you get back to your normal activities and a full range of movement. It takes time to get over surgery and you are likely to feel tired at first. The exercises will help to keep you moving and stop your shoulder and back from getting too stiff or tight.

You start by doing some gentle exercises and slowly build up to full movement over a number of weeks. This allows time for your body to heal. You can usually use your affected arm normally up to shoulder height for light activities from the day after your surgery. Your doctor will tell you if there is any reason why you shouldn’t do this.

To avoid stretching your wounds there are some movements you shouldn’t do in the first 1 to 2 weeks. Listen to your body. If you feel tired and achy, you might need to slow down. Your shoulder, chest and back may feel tight and uncomfortable, but it shouldn’t be too painful.

If you do have pain, stop and contact your specialist, physiotherapist or breast care nurse.

Things not to do in the first 2 weeks

There are some things you should try to avoid doing during the first 1 to 2 weeks after surgery. Your surgeon might suggest slightly different timings so check if you are unsure.

Avoid:

• lifting your arm above the height of your shoulder 
• lifting or pushing with your arm on the side you had surgery 
• lifting anything heavier than a bag of sugar 
• pushing yourself up from bed using the arm on the side you had surgery 
• pushing doors open 
• pulling anything towards you, for example pulling washing out of the washing machine

Avoiding these things helps your muscles to heal. It means that while it all settles down you don’t over stretch your wounds or the place where the muscle is now attached.

When you are fastening your bra, do it up at the front, swivel it round, and put your arm on the side you had surgery in first. When you put your coat on, make sure you put the side you had surgery in the armhole first.

The first 2 weeks after surgery

During the first 2 weeks, maintaining a good posture and doing the exercises helps to stop your shoulder, arm and back becoming stiff. This helps you get back to normal activities. Your shoulder, arm and back may feel stiff to start with. But the stiffness will ease off as you do the exercises and start to heal.

It is good to get moving about as soon as possible – gentle walking can help to maintain your fitness, will help you to heal, and make you feel better.

Maintaining a good posture

Try to maintain a good posture while doing the exercises so that you develop a good posture all the time. This helps the muscles get stronger.

You can keep good posture by:

• imagining that you have a piece of string pulling you up tall from the ceiling 
• thinking tall and straight 
• lifting your chest up 

You will probably feel that your back is quite tight – not just across the scar, but sometimes down the whole side of your back that you had surgery. This is quite normal, but uncomfortable, and can take a while to settle down.

Latissimus Dorsi Flap Breast Reconstruction Problems Years Later

Women who undergo a mastectomy to remove cancerous breast tissue often undergo reconstruction of one or both breasts. Different techniques can be used for breast reconstruction. A new breast can be made from tissue taken from the patient’s back, stomach, buttocks, or anywhere else on the body. This type of reconstruction is known as autologous reconstruction by medical professionals. Alternatives to metal implants include saline or silicone gel. Autologous reconstruction is followed by the insertion of an implant in some cases.

Three approaches to breast reconstruction were compared in a small study.

• LDR Flap Reconstruction: Latissimus Dorsi Muscle
• reconstructive implants
• Reconstructive Dielectric Electrophysiologic Potential Flap (DEIP)

Researchers compared the three procedures and discovered that latissimus dorsi flap reconstruction led to the most significant decline in shoulder strength, mobility, and function.

Assessment of Reconstruction Methods
Reconstruction via latissimus dorsi flap: The latissimus dorsi is a large muscle in your back that connects to the shoulder blade and the upper chest. It’s the muscle responsible for turning actions like tennis serve or golf club swing. An oval flap containing skin, fat, muscle, and blood vessels is removed from the patient’s upper back and used to reconstruct the breast in a latissimus dorsi flap procedure. To reconstruct the breast, this flap is subcutaneously transferred to the chest area. It is recommended that you keep the flap’s arteries and veins connected to their original blood supply in your back. A latissimus dorsi flap is categorized as a muscle-transfer flap due to the presence of so much muscle tissue within the flap. In spite of the fact that the skin on your back is typically a different color and texture than breast skin, a latissimus dorsi flap breast reconstruction can look very natural.

Reconstructive surgery using the abdominal artery known as the deep inferior epigastric perforator (DIEP) flap. To reconstruct the breast, the DIEP flap procedure involves removing fat, skin, and blood vessels from the abdominal wall and transferring them to the chest. Muscle is not removed during this procedure. Following careful dissection, your surgeon will use microsurgery to reconnect the flap’s blood vessels to your chest’s blood vessels. With a DIEP flap, most women have a shorter recovery time and a lower risk of losing abdominal muscle strength because no muscle is used. When it comes to flap surgery, a DIEP flap is one of the few that can be performed without sacrificing muscle.

Reconstructive implant surgery entails the placement of an implant, typically made of silicone gel or saline (salt water), either beneath or above the pectoral muscle to restore the appearance of a natural chest. Reconstructing the breast with an implant only requires incisions to be made in the chest, unlike flap reconstruction (and not a tissue donor site). Yet, it might necessitate more than one treatment. Since implants age and sometimes experience complications like scar tissue growing too tightly around the implant, it may be necessary to undergo additional surgery down the road.

Latissimus Dorsi Flap Reconstruction Technique

As the largest muscle in the body, the latissimus dorsi can stretch to cover wounds as wide as 20 by 40 centimeters. Donor function is not significantly impacted by the absence of this relatively large muscle. It’s the biggest flap that can be harvested from a single predicle, and it can be joined with other flaps like the serratus, scapular, and parascapular to cover huge wounds. The average person’s muscle is only about a centimeter thick, making it easy to drape over bumps and curves. One of the workhorses of reconstructive microsurgery alongside the rectus muscle and radial forearm flap. The latissimus becomes a usable muscle after being reinnervated via the thoracodorsal nerve.

ANATOMY
The muscle begins its development on the thoracolumbar fascia behind the midline and the iliac crest underneath. It serves as an adductor and internal rotator of the shoulder by inserting into the humerus. The posterior axillary fold is formed by the muscle’s most superior portion, just as it begins to narrow in preparation for its tendon of insertion. The thoracodorsal nerve, a limb of the brachial plexus’ posterior cord, provides the nerve supply. Latissimus function will be affected by lesions at C-7. Anatomically, the thoracodorsal artery and nerve are very close to one another.

Figure 1 of the Anatomy

A branch of the subscapular artery called the thoracodorsal artery supplies blood to the latissimus muscle. The artery is accompanied by the thoracodorsal nerve and a vein.

The subscapular artery, a trunk of the axillary artery, supplies blood to the latissimus muscle.

Prior to entering the muscle’s undersurface, the subscapular distributes a serratus branch and then sends off a circumflex scapular branch toward the back.

A pedicle of 5 to 15 centimeters can be harvested from the subscapular system. The artery is usually accompanied by a single venae commitans. You can either dissect the latissimus from the axilla and go straight for the pedicle, or you can follow the muscle’s underside from the far end to the near end. Since the artery branches within the muscle itself, it is possible to create a bilobed or double-tongued flap by cutting the muscle in half lengthwise. The partial superior latissimus flap harvests the upper part of the muscle from a transverse intramuscular branch of the thoracodorsal vessels.

Conclusión

The latissimus dorsi muscle, along with the skin and fat covering the muscle, is involved in breast reconstruction using back tissue. This procedure is called a latissimus dorsi (LD) flap. The tissue from your back is removed and moved to the front of your chest, with the arteries and veins still attached. Since most women do not have enough fatty tissue on their back to recreate a breast using only the LD flap, an implant or tissue expander is commonly used.