What the LD flap involves
The latissimus dorsi (LD) is a large, flat muscle that runs across the back. In LD flap reconstruction, a section of this muscle along with the overlying skin and fat is detached from its original position in the back and rotated forward on a blood vessel pedicle to the chest. The flap arrives at the chest wall with its own blood supply intact, making it a reliable and well-tested reconstruction option.
In most cases, a breast implant is placed under the LD flap to create the breast volume. The flap provides the soft tissue coverage and skin envelope, while the implant gives the shape and projection.
When the LD flap is preferred
The LD flap is particularly useful in situations where an implant alone would not have adequate coverage:
- After radiation therapy to the chest wall, where the skin is thickened and less pliable
- When the mastectomy skin flap is too thin or damaged to support a direct implant
- After failed implant reconstruction, when a natural tissue option is needed
- Patients who prefer a natural tissue reconstruction rather than implant alone
- When chest wall soft tissue coverage is inadequate for pre-pectoral or sub-pectoral implant placement
How the procedure is done
You will be under general anaesthesia. You are positioned on your side to allow access to both the back and chest in a single operation. The surgeon marks out the skin and muscle to be harvested from the back, based on the volume needed for reconstruction.
The LD muscle and skin island are carefully raised, keeping the thoracodorsal blood vessels intact. The flap is then tunnelled under the skin of the axilla and rotated forward to the chest. An implant is placed, the flap is shaped around it, and the donor site on the back is closed. The whole operation takes three to five hours.
The donor site
You will have a scar on your back, typically hidden by a bra strap line. Most patients find this acceptable once it has matured and faded. The back closure is done in a way that minimises visible contour changes.
The latissimus dorsi muscle has a compensatory function. Other back muscles take over its role, and most patients do not notice any lasting weakness in the shoulder or back. Some patients who do heavy overhead work or competitive swimming may notice a minor change, which is worth discussing before surgery.
Benefits of LD flap reconstruction
- Reliable blood supply with a long track record in breast reconstruction
- Provides good soft tissue coverage when the chest skin is damaged or tight
- Tolerates radiation well, making it a strong choice after radiotherapy
- Can be used when implant-only reconstruction has failed or is not suitable
Comparison to chest wall perforator flaps
The LD flap uses the muscle along with the overlying skin. Chest wall perforator flaps (such as LICAP or AICAP) take only the skin and fat from nearby chest wall areas, preserving the underlying muscle entirely. Perforator flaps reduce donor site morbidity but are technically more demanding and require the right anatomy. Dr. Shruthi will discuss which approach suits you best based on your body and reconstruction needs.
LD flap reconstruction is a longer operation than implant-only reconstruction and involves two wound sites. For the right patient, particularly after radiation or with thin skin, it offers a durable result that may not be achievable with implant alone.
Recovery
Hospital stay is typically three to five days. Recovery is longer than implant-only reconstruction, usually four to six weeks before returning to normal activity. Arm and shoulder physiotherapy starts early to maintain range of movement. Drains are placed in both the chest and back and are removed at home over one to two weeks.