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Latissimus dorsi flap reconstruction: using back muscle
A latissimus dorsi flap moves muscle, skin and fat from your back to rebuild the breast, often together with an implant. This page explains when surgeons suggest it, the different versions, what recovery involves, common issues such as back fluid and arm weakness, and what living with it is usually like.
MM
Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is a latissimus dorsi flap, and who might it suit?
- Common reasons for choosing an LD flap
- The main versions of the operation
- The vocabulary, in plain language
- Honest realities about the LD flap
- Recovering from an LD flap
- Living with an LD flap
- What people assume about the LD flap
- Common questions about the LD flap
The short answer
What is a latissimus dorsi flap, and who might it suit?
The latissimus dorsi is a large, flat muscle that spreads across the back, below the shoulder blade. In a latissimus dorsi flap, often shortened to LD flap, the surgeon lifts part of this muscle together with a patch of skin and fat and moves it around the side of the chest to the front, where it forms the new breast. Unlike a DIEP flap, the tissue stays attached to its own blood supply in the armpit, so no tiny vessels need to be joined under a microscope. This is called a pedicled flap, and it tends to be reliable, with total flap loss being rare. The back usually has less fat than the tummy, so for many people the flap does not provide enough volume on its own, and a breast implant is placed underneath it. Some people with more back fat can have an extended LD flap without an implant. The LD flap is often used when the tummy is not suitable, when someone prefers a shorter operation than a free flap, after radiotherapy when extra healthy tissue is needed over an implant, or to repair a lumpectomy defect. The trade-offs include a scar on the back, a common collection of fluid under the back wound, some weakness for certain arm movements, and occasional twitching of the rebuilt breast when the muscle contracts. Most people adapt well to everyday activities once they have recovered.
It uses back muscle and skin
Tissue is swung round to the front while staying attached to its blood supply.
An implant is often added
The back usually has less fat than the tummy.
It is generally reliable
Because no vessel joins are needed, total flap loss is uncommon.
This page gives general information only. Your surgeon can explain whether it suits you.When it is chosen
Common reasons for choosing an LD flap
Surgeons may suggest a back flap in several different situations.
The tummy is not suitable
A slim tummy, earlier abdominal surgery or a wish to avoid a tummy scar can make the back a good alternative donor site.
After radiotherapy
Radiotherapy can leave chest skin tight and thin. Healthy back tissue can cover an implant and help it settle more comfortably.
It is also used to rescue problem implant reconstructions.A shorter operation is preferred
Without microsurgery, the operation is usually shorter than a free flap, which may suit people with other health conditions.
Partial breast repair
A small LD flap can fill a large lumpectomy defect so the breast keeps a better shape.
Sometimes less suitable for
- Keen swimmers, climbers or tennis players
- People who rely heavily on arm strength for work
- People who have had back surgery on that side
Not sure whether this applies to you?
Ask an oncologistTypes of LD flap
The main versions of the operation
Version
What it involves
LD flap with implant
Muscle, skin and fat cover an implant, the most common approach when the back is slim
LD flap with tissue expander
An adjustable expander is placed and gradually filled, then swapped or kept as the final implant
Extended LD flap
Extra fat from the back is included so an implant may not be needed
Mini LD flap
A smaller piece fills a lumpectomy defect rather than building a whole breast
Muscle-sparing options
Some surgeons take mainly skin and fat on a small vessel, keeping most of the muscle
Words you may hear
The vocabulary, in plain language
- Latissimus dorsi
- The broad muscle across the back that helps pull the arm down and back.
- Pedicled flap
- Tissue moved while still attached to its original blood vessels.
- Skin paddle
- The oval of back skin moved with the flap, which may replace removed breast skin.
- Back seroma
- Fluid that collects under the back wound after the tissue is removed.
- Animation deformity
- Visible twitching or movement of the rebuilt breast when the moved muscle tightens.
- Tissue expander
- A temporary implant that can be filled gradually to stretch the tissues.
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Being straight with you
Honest realities about the LD flap
The LD flap is a well-established option, and it is fair to know its downsides too.
Back fluid is common
Many people develop a seroma on the back after drains come out, and it may need draining several times.
An implant brings its own issues
If an implant is used, problems such as hardening or the need for future replacement still apply.
What this page cannot tell you
It cannot tell you how your shoulder or back will feel afterwards. That depends on your activities, the amount of muscle used and your recovery.
After surgery
Recovering from an LD flap
Recovery is usually quicker than after a free tummy flap, but the back and shoulder need time and care.
In hospital
Most people stay a few days. You will have drains in the back and breast, and flap checks will be done, though less intensively than for a free flap.
Shoulder exercises
A physiotherapist will show you gentle arm and shoulder exercises. Doing them regularly helps prevent stiffness and restores movement.
Tightness across the back
Many people describe a band-like tightness across the back or under the arm for several months. It usually eases with exercise and time.
Getting back to activity
Most return to everyday activity within six to eight weeks, avoiding heavy lifting and strong pulling movements until the team advises.
Long term
Living with an LD flap
Once healed, most people manage household tasks and work without major difficulty.
Arm strength
Other muscles usually take over the job of the moved muscle. Some people notice weakness when pushing up from a chair, climbing, or doing strong pulling movements.
The back scar
The scar is often placed where a bra strap sits, so it can be hidden under most blouses and kurtas.
Breast movement
If the breast twitches when you use your arm, mention it. Surgeons can sometimes reduce this with a small procedure.
Commonly believed
What people assume about the LD flap
Losing a back muscle leaves your arm useless.
Other muscles compensate, and most people manage normal daily tasks well.
An LD flap is an old-fashioned choice.
It remains a reliable, widely used option for many situations.
You always need an implant with an LD flap.
An extended LD flap can sometimes provide enough volume on its own.
Fluid on the back means an infection.
A back seroma is common and usually harmless, though redness or fever needs a check.
Questions we are asked
Common questions about the LD flap
How long does LD flap surgery take?
An LD flap is usually shorter than a free flap such as a DIEP, often around three to four hours, though it can be longer if a mastectomy or node surgery is done at the same time. You may be turned onto your side during the operation so the surgeon can reach your back.
Where will the scar on my back be?
The back scar is often placed horizontally where a bra strap sits, or sometimes at an angle following the skin lines. Its length depends on how much skin is needed. Ask your surgeon to mark the planned position so you can think about clothing.
Why does fluid keep collecting on my back?
Removing the muscle leaves a space where fluid can gather after the drains come out. This is common. A nurse may drain it with a needle in clinic, sometimes more than once. It usually settles over a few weeks as the tissues stick back together.
Will I be able to do household chores?
Light tasks usually return within a few weeks. Heavier jobs such as lifting buckets, wringing clothes, sweeping with force or reaching high shelves are best built up slowly over the following weeks. Most people return to their normal routine once fully healed.
Can I play sport after an LD flap?
Many people return to walking, yoga, swimming and gym exercise. Sports needing strong pulling or overhead power, such as climbing, rowing or competitive swimming, may feel weaker. If sport matters greatly to you, discuss it before choosing this flap.
Can an LD flap be done after radiotherapy?
Yes. This is one of its common uses. Healthy tissue from the back, which has not been treated with radiotherapy, can replace or cover damaged chest skin and help an implant sit more comfortably than it would under treated skin alone.
Will my rebuilt breast match the other side?
Surgeons aim for a good match, but perfect symmetry is rare. Some people choose a later operation on the other breast, such as a lift or reduction, to improve balance. Nipple reconstruction or tattooing can also be added once the breast has settled.
Will the breast have normal feeling?
The rebuilt breast is usually numb or has reduced feeling, because the nerves to the breast skin are cut during mastectomy. Some sensation may slowly return around the edges over months or years, but normal feeling is not expected.
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Sources
- American Cancer Society — Breast reconstruction using your own tissue
- Macmillan Cancer Support — Breast reconstruction
- NHS — Breast reconstruction
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.