As an alternative to TRAM flap for breast reconstruction, LD myocutaneus flap with implant was used satisfactorily

1. Breast reconstruction –
Lattisimus Dorsi and Implant
Shailesh Nisal
Ramya Nisal
Sparsh Clinics Nagpur India
www.sparshclinics.com

2. 50 yr old, DCIS high grade central
quadrant tumor with few
subcentimeter axillary nodes

3. Plan - MRM with reconstruction by LD
+ Implant

4. MRM Defect, turned for LD harvest

5. Lat Dorsi Myocutaneus flap raised,
ready to be tunnelled

6. Closure of back, flap on chest

7. Implant in position after closure and
the next day

8. Day 4
Flap doing well
Projection adequate
Inframammary crease
in correct position

9. Week 2 – Oedema reducing, Flap and
implant doing well

10. DELAYED BREAST
RECONSTRUCTION

11. Mastectomy for Cystosarcoma
Phylloides 3 yrs ago

12. Planning….
Marking for Lat Dorsi and skin
Size of implant paddle

13. Landmarks in standing position

14. Harvest of Latissimus Dorsi
Myocutaneus Flap

15. Thoracodorsal Pedicle dissected and
skeletonized

16. Flap tunneled to chest, implant
readied for insertion

17. Implant placed, covered with muscle
from all sides, closure

18. Supported Bra

19. Good volume, IMF in correct position.
Absent nipple-areola, no ptosis.

20. Projection of breast equal, donor scar
acceptable

21. Massage inward and upward for
implant comfort

22. Before and after

23. Thanks …. Questions?
Shailesh nisal
Ramya nisal
sparsh clinics nagpur india
www.sparshclinics.com