Breast reconstruction using tissue from your back (LD flap)

LD flap breast reconstruction is an operation that creates a new breast shape using tissue taken from your back. 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. This creates a pedicled flap.

The LD flap stays attached to the original blood vessels and blood supply. The surgeon then positions it on your chest to make a new breast shape.

Because the LD flap stays attached to the original blood vessels and blood supply, there is a reduced risk of flap failure in the reconstructed breast.

You can have a combination of LD flap and implant reconstruction. An expander implant is more common in delayed reconstructions. The implant gives more volume to the breast. The flap covers the implant. This gives the breast a more natural look and feel.

LD flap with implant

Sometimes surgeons use liposuction to take fat from another part of the body. They then inject this into the muscle when you have your breast reconstruction, to create a reconstructed breast. This is called lipomodelling, lipofilling or fat grafting.

It may be used to create a larger breast shape so an implant is not needed.

LD flap with nipple prosthesis, and the scar on the back

Right LD flap reconstruction with fat grafting and nipple graft

Left LD delayed flap reconstruction with fat grafting

Occasionally, the surgeon moves a large amount of fat with the LD muscle. This is called an extended LD flap. It may be done so an implant is not needed. 

Extended LD flap and nipple reconstruction

• You will have a scar on your back and on the reconstructed breast.
• It may take several months for the muscle in your reconstructed breast 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.
• If you are having risk-reducing surgery and would prefer larger breasts, you may need LD flaps with implants or lipomodelling.
• You may need to have surgery to lift or reduce 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.
• There may be some tightness in your back after removing the LD muscle.

Front and back view 2 months after skin-sparing risk-reducing mastectomy using a latissimus-dorsi flap (without nipple reconstruction)

Skin-sparing risk-reducing mastectomy using an LD flap and nipple reconstruction (with tattooing)

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