What is the latissimus dorsi flap?
The latissimus dorsi is a large, flat muscle across your back, below the shoulder blade. In LD flap reconstruction, the surgeon moves a section of this muscle — along with the skin and fat over it — around to the front of the chest to rebuild the breast after a mastectomy. Because the tissue stays connected to its own blood vessels as it is rotated forward, it arrives with a reliable blood supply, which is one reason the LD flap has such a long, trusted track record.
You may hear it called several things — the LD flap, the lat flap, or simply a "back flap." They all mean the same operation.
With or without an implant
In most women, a small implant is placed underneath the LD flap to add volume and projection, while the flap provides soft, healthy tissue coverage and a natural skin envelope over it. In women with a fuller back, the flap alone can sometimes provide enough volume without an implant — this is called an extended LD flap. Your surgeon will advise which suits your body and the result you are hoping for.
Why an LD flap might be recommended for you
The LD flap is especially useful when an implant on its own would not have healthy enough tissue to sit under. Common reasons include:
- You have had, or will need, radiotherapy to the chest, which makes the skin tighter and less suitable for an implant alone
- The skin left after mastectomy is thin or has healed poorly
- A previous implant reconstruction did not work out and a tissue-based option is needed
- You would prefer a reconstruction that uses your own tissue
It brings fresh, well-supplied tissue from outside any radiated area, which is exactly why it is so often chosen after radiotherapy.
The LD flap is one of several reconstruction routes. Others include implant-only reconstruction, chest-wall perforator flaps (which spare the muscle), and abdominal-tissue flaps such as the DIEP. The best choice depends on your body, your treatment, and your priorities — there is rarely only one right answer.
What the operation involves
The surgery is done under general anaesthesia, usually with you positioned on your side so the surgeon can reach both the back and the chest. The muscle and skin are carefully lifted while keeping their blood vessels intact, tunnelled under the skin of the armpit, and shaped into a breast on the chest, often over an implant. It typically takes three to five hours. You can read the full step-by-step on the latissimus dorsi flap procedure page.
The scar on your back
Because tissue is taken from the back, you will have a scar there — usually placed along the line where a bra strap sits, so it is easy to conceal. Like all surgical scars it is more noticeable at first and fades over the following months. There is also a scar on the reconstructed breast. Your surgeon plans both to be as discreet as possible.
Will it affect my arm or shoulder?
This is the question most women ask, and the answer is reassuring. The latissimus dorsi has a "spare" quality — the surrounding back muscles take over its role, so everyday activities such as reaching, driving, and lifting are not affected for the vast majority of women. If you are a competitive swimmer, a rock climber, or do heavy overhead manual work, it is worth a specific conversation beforehand, as a small number of people in these groups notice a subtle change.
Recovery
An LD flap is a bigger operation than implant-only reconstruction, with two wound sites, so recovery is a little longer — typically a hospital stay of three to five days and around four to six weeks before returning to normal activity. Gentle shoulder physiotherapy starts early to keep your movement, and drains are usually placed in both the chest and back and removed over the first week or two. For a full picture of healing, see our guide on recovery after breast surgery.
Reconstruction is a personal choice, and it can be delayed. It can be done at the same time as the mastectomy (immediate) or months to years later (delayed). Taking time to decide does not close the door — you can explore reconstruction whenever you feel ready.
Is the LD flap right for me?
For the right woman — particularly after radiotherapy, or when the chest skin is thin — the LD flap offers a soft, durable, natural-feeling result that an implant alone often cannot. For others, a simpler implant reconstruction or a perforator flap may be a better fit. The way to know is a consultation where your anatomy, your cancer treatment, and what matters to you are all weighed together.
Dr. Shruthi Neela performs and advises on the full range of breast reconstruction options at Sindhu Hospitals, Hyderabad. A consultation — or a second opinion — is the place to talk through what would suit you.