1. Latissimus Dorsi Flap Stephen McCulley MBChB,FCS(SA)Plast, FRCS(Plast) Consultant Plastic Surgeon Nottingham, UK Cairo, March 2011

4. Surface Anatomy

5. Vascular supply Angiosomes and Venosomes

6. Layers in standard LD flap harvest

7. Layers in extended LD flap harvest

9. Standard LD and ELD flap

11. Immediate Breast Reconstruction with no chance radiotherapy Extended LD flap LD flap/Implant DIEP flap

12. IMMEDIATE RECONSTRUCTION LD flap and implant

15. Left Mastectomy and Extended LD flap (no implant)

16. Immediate Breast Reconstruction with chance radiotherapy Extended LD flap DIEP flap LD flap/Implant

18. Radiotherapy change after LD flap

19. Delayed Breast Reconstruction DIEP flap Extended LD flap LD flap/implant

20. LD flap and implant and C/L implant

22. Limited skin on flap and high scar

23. Pre-op 6 months 3 years

28. Planning with relation to clothes

31. Planning with relation to flap volume requirements

32. Maximising volume

36. Immediate and delayed LD Reconstruction with large skin volumes available

37. X Y Z X – Y = Z (ideally!)

41. Planning LD and Implant

44. Planning – Mastecomy to final result

68. Folding of flaps

71. Secondary Extended LD flap Left LD and implant and right and nipple share reconstruction breast augmentation (awaiting tattoo)

73. Secondary correction with LD flaps

75. 3 weeks post surgery

76. Failed TRAM flap salvaged with an Extended LD flap

81. Delayed reconstruction with LD flaps and contralateral augmentation

82. Planning – Mastecomy to final result

87. Round Low cohesive Moderate profile

88. Round High profile

89. MX on left and MM on right

90. Avoiding complications

91. Back wound problems and seromas -use of steroid

92. Infected implant after LD flap

93. Implant wrinkling after LD flap

94. Radiotherapy change after LD flap

95. Capsule formation after LD flap and implant

99. Thank you