Your latissimus dorsi muscle is located in your back, just below your shoulder and behind your armpit. It's the muscle that helps you do twisting movements, such as swinging a racquet or golf club. In a latissimus dorsi flap procedure, an oval flap of skin, fat, muscle, and blood vessels from your upper back are used to reconstruct the breast. This flap is moved under your skin around to your chest to rebuild your breast. The blood vessels (artery and vein) of the flap are left attached to their original blood supply in your back. Because the flap contains a significant amount of muscle, a latissimus dorsi flap is considered a muscle-transfer type of flap.
While the skin on your back usually has a slightly different color and texture than breast skin, latissimus dorsi flap breast reconstruction can look very natural.
Because the donor site for the latissimus dorsi flap is closer to the chest than the donor sites for abdominal tissue flaps, and because the blood vessels in the back are usually strong, the latissimus dorsi flap may be a good reconstruction choice for women who are not good candidates for TRAM, DIEP, or SIEA flaps for a number of different reasons, such as:
- There’s not enough donor tissue in the abdomen.
- They’ve had previous flaps that failed and need a secondary alternative.
- They don’t have access to plastic surgeons who can perform the microsurgery that free flaps require.
The latissimus dorsi flap may be a good option for women with small- to medium/small-sized breasts because there's usually not much fat on this part of the back. In most cases, a breast implant has to be placed under the flap to achieve the desired shape, size, and projection. A latissimus dorsi flap procedure leaves a scar on your back, but most surgeons try to place the incision so the scar is covered by your bra strap.
While the latissimus dorsi flap may offer good results with few complications, it does have some drawbacks:
- You may have partial loss of strength or function that makes it hard to lift things and twist. This can affect your ability to perform certain swimming, golf, or tennis strokes, or turn and manipulate objects. So it’s generally not a good choice for bilateral reconstruction, because you could then have muscle issues on both sides.
- Most women need an implant along with a latissimus dorsi flap, and some women say the implant feels firmer than the tissue in front of it.
- The fat around the latissimus muscle is stiffer than fat that comes from the belly area, so some women say that their latissimus dorsi reconstructed breast feels "tighter" than their other breast.
Learn more about latissimus dorsi flap reconstruction on these pages: