Breast reconstruction using tissue from your back (latissimus dorsi flap or LD flap)

The flap and its blood supply are tunnelled under the skin below your armpit and put into position on your chest to make a new breast shape.

Occasionally, a large amount of fat is taken with the muscle. This is called an extended latissimus dorsi flap and may be done so that an implant isn’t needed.

The photo on the left is of someone who has had immediate reconstruction with  latissimus dorsi flap (no implant).  Some women prefer not to have nipple reconstruction|.

The photo on the right shows someone who has had right-sided latissimus dorsi flap and nipple reconstruction. The left breast has been enlarged with an implant.  

  

 

A latissimus dorsi flap may be suitable for women who:

It may not be suitable for women:

• with very large breasts
• who are very overweight.

Benefits Back to top

• A latissimus dorsi flap can match most breast sizes well.
• The breast looks and feels more natural than with an implant only.
• It has a high success rate and problems with the flap are rare.

Limitations Back to top

• The operation takes up to four hours and recovery time can be up to three months.
• You will have a scar on your back. This is usually horizontal across the part of your back the muscle is taken from, but won’t be seen under a bra. Sometimes the scar is at more of an angle (diagonal) and more difficult to cover with a bra, but can be covered with a swimsuit.
• There will be an oval scar around the reconstructed breast. The skin on your back is a slightly different texture and colour from the skin on your chest, so the colour of the reconstructed breast may not completely match that of the other breast.
• There will be a small bulge under your armpit where the muscle is tunnelled under the skin.
• The breast will have little or no sensation (it will feel numb).
• You may need to have surgery to lift or reduce the size of your natural breast to get a good match.
• If you are having a larger breast reconstructed, you may need an implant as well.

Risks Back to top

Fluid under the back wound (seroma|) This is the most common problem soon after LD flap surgery. Seromas usually get better with time as the body heals, although they may need to be drained. Occasionally seromas persist (chronic seroma) and need extra treatment.

Shoulder weakness

After the operation you will have some weakness in your back and shoulder. This will improve over time as there are many muscles in the back that can compensate for the loss of the LD muscle. You should regain full shoulder strength for most activities 6-12 months after the surgery, although you may notice weakness during some movements, such as pushing up to get out of the bath. Most women can return to daily activities, including sports such as swimming and tennis, without any problems. However, the ability to take part in sports such as rowing, rock climbing, cross-country skiing or playing competitive racquet sports at a high level are likely to be affected by LD flap surgery.