Using tissue from your back

Some women have their breast(s) reconstructed using muscle, fat and skin from their back. This is called a latissimus dorsi flap (LD flap). It has a high success rate and problems are rare.

Sometimes an LD flap is used with a breast implant to give a more natural feel than an implant alone. It may be used after breast conserving surgery if a large amount of breast tissue has been removed.

It is suitable for women with most breast sizes except for women with very large breasts. It’s not usually suitable for women who are very overweight.

After the operation fluid may build-up (seroma) under the wound but this usually settles as the body heals. This operation can cause weakness in your back and shoulder to begin with, but this gets less with time. There may be some long term weakness with some movements, such as reaching above shoulder height. But women usually return to daily activities, without any problems.

Reconstructing breasts with a LD flap

This operation uses a muscle called the latissimus dorsi and some overlying fat and skin from your back.

This is known as a latissimus dorsi flap or LD flap. In this operation, the surgeon uses a muscle called the latissimus dorsi and some overlying fat and skin from your back. 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, the surgeon removes a large amount of fat with the muscle. This is called an extended latissimus dorsi flap and may be done so that an implant isn’t needed.

Latissimus dorsi flap(front)
Latissimus dorsi flap(front)

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Latissimus dorsi flap(back)
Latissimus dorsi flap(back)

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Extended latissimus dorsi flap
Extended latissimus dorsi flap

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A latissimus dorsi flap may be suitable for women who:

  • have small, medium or large breasts
  • need breast reconstruction after a lumpectomy (wide local excision).

It may not be suitable for women:

  • with very large breasts
  • who are very overweight.


Benefits of LD flap

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


Limitations of LD flap

  • The operation takes between 3–6 hours (depending on whether you are having one or both breasts reconstructed) and recovery time can be up to three months.
  • You will have a scar on your back. This 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 a scar on the reconstructed breast(s). The skin on your back is a slightly different texture and colour from the skin on your chest so the patch of skin on the reconstructed breast may not completely match that of the other breast (if you are only having one breast reconstructed).
  • There may be a small bulge under your armpit where the muscle is tunneled under the skin.
  • The breast(s) will have less sensation than the original breast (it may feel numb).
  • It may take several months for the muscle to feel part of the breast and not the shoulder.
  • Some women notice their reconstructed breast twitches or jumps when they cough or sneeze. Most women aren’t too troubled by this. But, if it is very troublesome it may be stopped with an operation to the nerve which runs to the LD muscle in the breast.
  • If you’re only having one breast reconstructed, 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

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 they 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 within about six months after the surgery. You may notice weakness during some movements, such as pushing up to get out of the bath or when reaching above shoulder height eg when climbing a ladder.

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.


Back to Types of breast reconstruction

Surgery to the other breast

Some women have an operation on their natural breast so that the reconstructed and natural breasts look as similar as possible.