Kindly give your valuable advice on the reconstruction for this lady whose photograph I am attaching.

She underwent Modified radical mastectomy left for Ca breast. In an attempt to close the wound primarily ,a bipedicle flap has been elevated with a subcostal incision and a graft has been placed on the donor site.Her deep margin is positive. Her inferior flap is necrosed near the margin.She has to undergo radiotherapy. She has been referred to me for debridment and possible Latissimus dorsi myocutaneous flap reconstruction to replace the necrosed skin.

I am worried as to the future of this inferior flap when I elevate the LD. What is the best option for this lady? If I should do an LD flap where should my incision lie?

(Sorry for the poor quality of photograph as these are the ones I have received from the operating surgeon- yet to see the patient directly)

Nandini.R