A latissimus dorsi flap moves a section of back muscle, along with the skin and fat covering it, to the chest. It is often paired with an implant or tissue expander.
This page explains how the operation works, why an implant is usually part of it, and what is known about recovery and complications. For the wider picture of options and timing, see the guide to breast reconstruction.
| Item | What to know |
|---|---|
| Tissue used | Back muscle with the skin and fat covering it |
| Implant or expander | Commonly used, as most women lack enough back fat |
| Back scar | Often placed so your bra will hide it |
| Armpit bulk | Decreases over time but may never disappear |
| Hospital stay | An average of 2 days in one review |
These points come from MD Anderson Cancer Center and a Mayo Clinic surgeons’ review; information can change, so please check the sources for the latest.
The latissimus dorsi flap defined
The latissimus dorsi is a broad, flat muscle of the back. According to MD Anderson Cancer Center, “When back tissue is used for breast reconstruction, it involves the latissimus dorsi muscle, along with the skin and fat that covers the muscle.” That unit of tissue is called a flap, and the technique is often shortened to LD flap.
The flap stays attached to its own arteries and veins, so it keeps its blood supply while it travels. A patient-education summary from Healthwise describes it as using “muscle, fat, and skin from the upper back that is pulled under the skin to the chest area.” In other words, the tissue is tunnelled beneath the skin from the back to the front rather than being fully detached and reconnected with microsurgery.
The muscle is not limited to mastectomy reconstruction. After breast conservation surgery, it can also be used to fill a misshapen area left behind when breast tissue is removed.
The role of an implant or tissue expander
Most people do not have a large amount of fat on the back. MD Anderson explains it this way: “Since most women do not have enough fatty tissue on their back to recreate a breast using only the LD flap, an implant or tissue expander is commonly used.”
The muscle and skin from the back therefore serve two roles. The skin paddle can replace skin that was removed during the mastectomy, and the muscle forms a layer of coverage over the implant. An implant can sometimes be placed during the same operation, and the Healthwise summary notes this is done to make the breast larger.
When a tissue expander is placed under the flap first, a later operation is usually needed. MD Anderson says that an additional surgery is often necessary to replace the expander with a permanent silicone or saline implant. People who are curious about how expanders work can read about the stepwise process in the separate article on tissue expanders.
Planning the operation
The incision on the back is placed according to how much skin is needed to replace the skin removed with the mastectomy. MD Anderson says the incision can often be placed so that a bra will hide the scar, and the Healthwise summary likewise says the scar can be placed at the bra line.
Planning also depends on whether reconstruction happens at the time of the mastectomy or later. Each approach has its own considerations, which are covered in the article on immediate vs delayed breast reconstruction. A latissimus dorsi flap has been used in both settings. A review by Mayo Clinic surgeons reports using the flap with a tissue expander for both delayed and immediate reconstruction.
Other factors that commonly shape the choice of technique include the need for additional cancer treatment, lifestyle, the appearance a person wants and the surgeon’s experience. The same review describes the type and timing of reconstruction as a multifactorial decision.
Advantages and drawbacks
The table below condenses the advantages and disadvantages listed by one major cancer centre.
| Advantages | Disadvantages |
|---|---|
| Decreased surgery and recovery time | A breast implant is usually required for the desired projection and size |
| Better coverage over the implant | May have complications in the back where the tissue was taken from |
| One-time surgery, if the implant is placed immediately | Muscle weakness in the back can affect some athletes |
| Good option for thin patients who have had radiation therapy | Bulky area underneath the armpit |
The lists come from MD Anderson’s patient page on back tissue reconstruction, which names rock climbers, swimmers and tennis players as the people most likely to notice back muscle weakness.
The bulky area under the armpit deserves a note. MD Anderson says the back tissue rotated to the chest “will result in a bulky area underneath the armpit.” It adds that this will decrease over time but may never disappear.
Recovery and complications
The authors of the review describe the operation as technically straightforward and report that hospitalization is an average of 2 days, which they say compares favourably with the TRAM flap. Hospital stays vary by person and by hospital, so this is only a reference point from that one centre’s experience, published in the review itself.
Two complications come up repeatedly in the literature. The first is capsular contracture, in which scar tissue tightens around an implant. In the same review, the authors report that their review of more than 200 patients, including radiated and nonradiated breasts, confirms a capsular contracture rate of any grade of 10.5%. The second is seroma, a collection of fluid at the back or the breast. The review states that “Seroma, both donor site and breast, remains significant (24.5%).”
The authors also note that the evidence base is limited. In their words, there is a paucity of published studies, and most studies have small numbers. Rates reported in early series differ widely from more recent ones, so any single figure should be read as a snapshot from one group of patients rather than a prediction for an individual.
MD Anderson states that patients generally have no major long-term problems from the flap and can resume activities of daily living and exercise as before surgery. People who take part in activities that depend heavily on back strength are the ones most likely to notice a difference.
Comparison with abdominal flaps
The latissimus dorsi flap has a long history. According to the review by Mayo Clinic surgeons, its use has always been as a secondary technique, particularly after the development of the transverse rectus abdominus myocutaneous flap in the 1980s. The authors argue that the flap was unfairly criticized because much of the older data on it was outdated and small in scale.
Abdominal techniques use tissue from the belly instead of the back, and they do not usually require an implant. You can read how the pedicled and free versions differ in the article on TRAM flap reconstruction. The choice between a back flap and an abdominal flap depends on how much tissue is available, past surgery and radiation, and personal priorities.
Decisions about surgery and recovery belong with your own surgeon and care team. They can assess your anatomy, your cancer treatment plan and your goals, and explain which options are realistic. This page offers general information only and is not medical advice.
Frequently asked questions
Does a latissimus dorsi flap always need an implant?
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Not always, but it is common. MD Anderson says most women do not have enough fatty tissue on the back to recreate a breast using only the flap, so an implant or tissue expander is commonly used.
Where is the scar after a latissimus dorsi flap?
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There is a scar on the back as well as on the chest. The back incision can often be placed so that a bra hides it, according to MD Anderson and Healthwise.
Will back strength be affected?
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MD Anderson says patients generally have no major long-term problems and can resume everyday activities and exercise as before, though back muscle weakness can affect rock climbers, swimmers and tennis players.
Can the flap be used after a lumpectomy?
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Yes, in some cases. MD Anderson says it can be used after breast conservation surgery to fill a misshapen area that can result when breast tissue is removed.
