Breast reconstruction using tissue from your back (LD flap)

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.

This photograph shows a woman who has had a latissimus dorsi flap to her right breast. She has also had a nipple reconstruction.

This photograph is taken from the back. It shows a horizontal scar going from the mid back to under the arm in a woman who has had a latissimus dorsi flap to her right breast.

The photograph shows a woman who has had an extended latissimus dorsi flap to her left breast and a nipple reconstruction.

This photograph shows a woman who has had a latissimus dorsi flap to her right breast with an implant. She has not had nipple reconstruction.

This photograph shows a woman who has had a delayed latissimus dorsi flap to her left breast with lipomodelling. She has not had nipple reconstruction.

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?

With any operation, there are risks, such as infection. There are also some specific risks with this type of reconstruction.

Build-up of fluid (seroma) under the wound on the back

This sometimes happens after the operation but usually gets better within a few weeks.

Changes in sensation

Sometimes surgery can cause numbness, pain or oversensitivity in the area of your back where the tissue was taken from. The chance of this happening is higher after an extended LD flap operation, where more tissue is taken from the back.

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.

About our information

References

Below is a sample of the sources used in our breast cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

European Society for Medical Oncology. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of oncology 26 (supplement 5): v8–v30. 2015.

Morrow M, et al. Chapter 79: malignant tumors of the breast. DeVita, Hellman and Rosenberg’s cancer: principals and practice of oncology (10th edition). Lippincott Williams and Wilkins. 2014.

National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. July 2018.

Scottish Intercollegiate Guidelines Network. SIGN 134. Treatment of primary breast cancer: a national clinical guideline. September 2013.

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Rebecca Roylance, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.