What is a LAT Flap?
Houston, TX board-certified plastic and reconstructive surgeon Dr. Aldona J. Spiegel can offer breast cancer patients a latissimus flap reconstruction. This type of flap requires the entire latissimus dorsi muscle, fat tissues, and an ellipse of skin for reconstruction. As it is not a muscle-sparing surgery, the LAT flap may or may not require a tissue expander first before the autologous tissue can be relocated to the chest. This technique does require the sacrifice of your shoulder strength, even though the rotary cuff area will take on the functionality for activities that do not require a strong pulling, pushing, or climbing movement.
We can assess your LAT flap eligibility in a consultation in our office in Houston, TX at Aldona J. Spiegel, M.D. One of our friendly patient care coordinators would be happy to take your information over the phone and schedule an appointment for you to meet with our esteemed surgeon.
"I cannot recommend Dr Spiegel and her team more highly. I attended her clinic when having trouble with uncomfortable implants after a previous mastectomy. Dr Spiegel suggested DIEP procedure and I was really not sure. Over the coming months both she and her team explained the procedure, the benefits and results and implications. I decided to go ahead and I could not be more happy with the results. I look like I would have done pre mastectomy. I have been amazed by the continued care and concern of the whole team from the finance folk to the clinic nurses and doctors and their absolute pleasure in seeing my delight. A fantastic experience and I can't thank them enough."- C.A. / Google / Aug 01, 2019
"Dr. Spiegel and her wonderful staff got me through the most difficult experience of my life. Going through mastectomy and DIEP flap reconstruction is traumatic. I chose her over other Houston area surgeons and felt that I could trust her. Everyone in her office supported me each step of the way. First, and foremost, this is a major surgery and you rely on medical excellence to avoid important risks. She is a perfectionist regarding medical safety. Next, her artistry is outstanding. She got the best result that could be possible. Finally, if you have radiation, it is a long journey of several years to get from the beginning to end of the process, involving a year of a temporary expander before the final reconstruction. It is important to have a team that you can have that trusting supportive relationship over time. I feel very lucky and grateful that I was in the hands of this wonderful group of highly skilled women."- L.S. / Google / Jul 08, 2019
"Dr. Spiegel was highly recommended by my oncologist. It had become necessary that I look into reconstruction and a lymph node transplant. Dr. Spiegel does amazing work. She loves what she does and it shows in the results that she achieves. I am very happy that I chose her for this journey! Her support staff are wonderful to work with as well!"- D.M. / Google / Jul 08, 2019
"Dr. Spiegel is my guardian angel and I owe her and her entire team and staff a debt of gratitude that I will ever be able to repay! I am one year out from my original Diep flap surgery with her and I feel great- like myself again! After undergoing a prophylactic mastectomy ( due to testing positive for the BRCA 2 gene and strong family cancer) and getting breast implants with another doctor, Dr. Spiegel saved my life by removing the implants and performing Deip surgery. The implants cased me so much pain and diminished my quality of life but now I have it back. I have no more pain and my breasts are soft again and created from my very own tissue. Thank you Dr. Spiegel!"- J.A. / Google / Jul 08, 2019
"Dr. Spiegel is simply fantastic. I am so grateful to her and her whole staff (Alexis/Nicole/Lisa/Aidee/Angie) for the wonderful care and support given to me from my very first visit to their office. Dr. Spiegel is so thorough that during the course of my visits, she insisted that I consult a GI doctor for my distended stomach. Turns out that I had an H Pylori infection for which I had to be treated. No other doctors had ever looked past their specialties to treat the whole individual, and I am 59 years old. Subsequently, Dr. Spiegel pushed for an endoscopy, and it was discovered that I had an ulcer for which I was treated. From cardio work up, lab tests to chest xrays, Dr. Spiegel ensured that I was in top shape for surgery and made sure that I understood all aspects of the procedure and treatment.During my stay at the hospital, Dr. Spiegel, Alexis, Nicole, Dr. Arroyo, and Dr. Vo infused me with so much strength, support and kindness that I have no words to express my gratitude and appreciation. It's been one month since my surgery and I'm feeling good, healing very well and going back to work next week. Awesome doctor and wonderful staff."- R.L. / Google / Jun 08, 2019
Am I Suitable for a Lat Flap?
Women who are best suited for a LAT flap will have ample tissue in the "lat" or back area to harvest for autologous breast reconstruction. Dr. Spiegel generally suggests the LAT flap to women who do not have enough donor tissue in the abdomen. This procedure is not ideal for women who need their upper body strength as the LAT muscle will be detached for this procedure.
How is a LAT FLap Performed?
The LAT flap breast reconstruction will be performed at a local hospital where you will be admitted. This surgery may last 4 – 7 hours, and we want to make sure that you are closely watched for your health and safety afterward. When you are under general anesthesia, Dr. Spiegel will make an incision along the bra line to harvest the latissimus dorsi myocutaneous for the flap. Every part of this tissue is kept together and relocated from the back to the breast in one movement. She will create your breasts from the fan-shaped muscle, fat tissue, and skin. An ellipse of skin will also be excised to replace the skin where the nipple was taken in the mastectomy.
Dr. Spiegel will close your incisions with absorbable sutures. She will also place a Doppler wire and drains into each flap. You will then be taken into the recovery room. Our post-operation nurses will monitor and track all your vital signs, pain, and level of blood flow in your newly established flaps. You will be in the hospital after your surgery, and this is a precaution we take in case something happens with the viability of the breast flaps. Without proper blood flow, the flap can be compromised. If that does happen, you will already be in the hospital where your needs can be immediately addressed.
Monitor the Flap at Home
At home, you will keep a close eye on your LAT flaps. You will be looking for new changes, managing your drains, and checking on the blood flow with the Doppler signal. Your skin should look like your normal back skin. If it is discolored, this could be a warning that something needs to be checked by the doctor. Call our office for medical assistance right away if you have fever, infection, or excessive pain.
Changes you see
You will definitely experience swelling after your surgery, and that is a normal body response. You may even have post-op swelling for a month after your surgery. However, if the swelling has you concerned, please do not hesitate to reach out to Dr. Spiegel. It is also common to see and feel knots in the incision sites. Dr. Spiegel can address the knots in your follow-up visits. We ask that you wait to shower after the first 48 hours after surgery.
We will ask you to document the output of fluid you excrete from each of your drains. The drains will be placed in every surgical site. We will decide when it is appropriate to remove your drains.
To monitor your blood flow at home, you will have a Doppler wire implanted in your flaps. You will go home with this bandaged in a way that it will be waterproof. It will be safe to shower with the Doppler. It will be removed at a post-op visit.
If you need medical advice or assistance during your flap recovery, please get in touch with our team at Aldona J. Spiegel, M.D. We want to keep your breast flaps healthy!
Follow-up and Recovery
Just like the DIEP flap breast reconstruction, the LAT flap is a very similar recovery. You will need to buy a fitted compression garment at our office after your surgery to wear during your recovery. You can also get medical reimbursement from your insurance for the cost of the garment. This special garment will help you feel better by limiting your swelling, relieving some of the pain, and supporting your back.
We ask that you take about four weeks off from work if you have a job that is not physical and more if you perform a lot of physical activity. You should not drive for two of those weeks because of the pain medication you will be taking. During this time, you will also need to sleep in a recliner to protect the incisions and tension on your surgical sites.
Your exercise after this surgery will consist of taking walks and doing light activities around your house as long as you lift nothing more than five pounds. Even if you feel up to it, Dr. Spiegel would like you to wait for two months to start exercising as you did before surgery. Any core work, like sit-ups or crunches, should be postponed for six months.
If one of your doctors request that you get a mammogram, please do as directed. Usually, a routine mammogram is not needed for a woman with no breast tissue, but it can be performed on a reconstructed breast.
Emotional Support available
At Aldona J. Spiegel, M.D., we have emotional support services available for our breast cancer patients in a program called "The Pink Sisters." This program is open to you through our practice after you have been through the consultation process and decided on which surgery you will have to reconstruct your breasts. We will even pair you up with one of the Pink Sisters who has been through the surgical process just like yours to help guide you along the way as you may have comparable medical situations to discuss. It is our hope that you will find comfort in this matched relationship as you embark on your own breast reconstruction.
Meet with us in Houston, TX
We would be delighted to discuss LAT flap breast reconstruction with you at Aldona J. Spiegel, M.D. Schedule your consultation with one of our friendly patient care coordinators. We can tell you about the benefits of autologous flap breast reconstruction using the latissimus dorsi myocutaneous flap. No matter what stage you are in your breast cancer journey, Dr. Spiegel in Houston, TX would like to offer her excellent surgical skills to recreate your breasts. You can reach us by calling our office or requesting an appointment online.