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Back Based Reconstruction

Back Based Reconstruction: Overview

The latissimus is a broad, flat muscle of the back that is commonly used in breast reconstruction. The muscle provides excellent coverage of the chest wall, but is usually insufficient to re-create the breast mound entirely. Thus, the latissimus muscle is typically used for coverage and support, and is paired with a breast implant to provide volume during a back based reconstruction.

Before & After

38 year old woman with prior implant based reconstruction and right breast radiation. Final photo is 2 years after right sided latissimus muscle/skin flap and implant and left implant exchange with nipple tattooing.

The Operation

The latissimus muscle gets its blood supply from the armpit. When dissected from the back, it can pivot or swing, tethered by this blood supply, to the chest. The muscle can be used to support & create a pocket for a tissue expander. If needed, back skin that is overlying the muscle can be moved as well.

What To Expect

Plastic Surgery Northwest surgeons use the latissimus muscle in two ways for breast reconstruction. For women having a mastectomy, the muscle alone can be used at the time of tissue expander placement, to create a support structure for the expander in the lower pole of the breast, and provide additional coverage with a good blood supply. For women who have had prior mastectomy and radiation, the latissimus muscle and skin flap can provide non-radiated tissue to cover a tissue expander, and non-radiated skin to improve the expansion process. In both situations, the tissue expander will be used to stretch the surrounding skin prior to being exchanged for a permanent breast implant after a back based reconstruction.

Before & After

Nipple sparing mastectomy in 42 year old woman utilizing only a portion of the latissimus muscle (“split latissimus”) without a back scar

Image by Greg Rosenke
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