About latissimus dorsi flap (LD) flap breast reconstruction
The surgeon uses a muscle called the latissimus dorsi (LD) and some overlying fat and skin from your back. They tunnel the flap and its blood supply under the skin below your armpit. They then put it into position on your chest to make a new breast shape.
LD flap and implant reconstruction
Some women have a combination of an LD flap and implant reconstruction. The implant gives more volume to the breast. The flap covers the implant. This gives the breast(s) a more natural look and feel.
Lipomodelling
Sometimes, surgeons use liposuction to take fat from another part of the body. They then inject this into the muscle to create a reconstructed breast. This is called lipomodelling. It may be used to create a larger breast shape so an implant is not needed.
Extended LD flap
Occasionally, the surgeon moves a large amount of fat with the LD muscle. This is called an extended latissimus dorsi flap. It may be done so an implant is not needed.
Who might it be suitable for?
Using tissue from the back may be suitable for women with breasts of any size.
It may not be suitable for women who have jobs or hobbies that involve:
- using their arms above shoulder height
- heavy lifting
- climbing.
What are the limitations?
- You will have a scar on your back and on the reconstructed breast(s).
- It may take several months for the muscle in your reconstructed breast(s) to feel part of the breast and not the back. The muscle may twitch sometimes.
- If you have larger breasts, you may need an implant or lipomodelling as well as the LD muscle to match your other breast.
- You may need to have surgery to lift or reduce the size of your natural breast so both breasts are a good match.
- There may be a small bulge under your armpit where the muscle is tunnelled under the skin. You may feel fullness under your arm. This usually improves over time but may not go away completely.
What are the risks?
Build-up of fluid (seroma) under the wound on the back
Changes in sensation
Shoulder weakness
After the operation, you will have some weakness in your back and shoulder. This will improve over time. There are other muscles in the back that can compensate for the loss of the LD muscle. You should regain full shoulder strength for most activities 6 to 12 months after surgery. But, you may notice weakness during some movements. For example, you may have problems with:
- pushing your arms down to get out of the bath
- raising your arms above shoulder height.
Most women can return to daily activities without any problems, including sports such as swimming and tennis. However, having LD flap surgery can affect your ability to take part in some sports, such as:
- rowing
- rock climbing
- cross-country skiing
- high-level competitive racquet sports.