Medical Oncologist
CION Cancer Clinics
LD flap reconstruction, explained | CION Cancer Clinics
A latissimus dorsi (LD) flap rebuilds the breast with skin, fat and the broad muscle of your upper back, tunnelled under the armpit to the chest while still attached to its own blood supply. Because the back tissue is thin, it is usually paired with an implant. It suits slim women and chest walls that have had radiation, and needs no microsurgery. This page explains what you gain and what you give up. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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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 an LD flap reconstruction?
- What actually happens during the operation?
- What do you gain, and what does it cost you?
- Words you will hear, in plain language
- Four things families tell us, and what is actually true
- What this page cannot tell you, and what to ask
- Common questions about LD flap reconstruction
The short answer
What is an LD flap reconstruction?
An LD flap rebuilds the breast using skin, fat and the broad, flat muscle of your upper back, called the latissimus dorsi. The tissue is tunnelled under the skin of the armpit to the front of the chest while still attached to its own blood supply. Because the back tissue is thin, it is usually combined with an implant to make up the size.
Why a surgeon might suggest it
It brings fresh, healthy skin and muscle to a chest wall that has had radiation, where an implant alone would sit under tight, damaged skin. It does not need microsurgery, so it is offered at more centres than a DIEP flap. And it suits slim women who do not have enough tummy tissue for a tummy flap.
What you are giving up
The muscle that helps pull the arm down and back, used in swimming, climbing and pushing up from a chair. Most women notice little change once healed, because other muscles take over. If your work or sport depends on that movement, say so. There is also a back scar, usually placed so a bra strap hides it.
Who it does not suit
Women who have had previous surgery through that part of the back, women who want to avoid any implant, and women for whom the extra muscle matters, such as wheelchair users or those with a very active job.
This page explains the operation. Whether it is the right one for you is a judgement your surgeon makes after examining your chest, back and tummy.In theatre
What actually happens during the operation?
Marking and positioning
The surgeon draws the flap on your back while you are awake and standing, so the scar can be placed where clothing covers it. Under anaesthetic you are turned onto your side or front.
Lifting the flap
An oval of skin with the fat and muscle beneath is freed from the back, keeping the blood vessels that run up into the armpit attached. The back wound is closed and a drain is placed.
Tunnelling to the chest
You are turned onto your back. The flap is passed under the skin of the armpit to the front and laid over the chest wall to make the new breast skin and padding.
Shaping, and the implant
If an implant or expander is needed for size, it is placed under the muscle. The flap is shaped and stitched, drains are placed, and you go to recovery. The whole operation usually takes several hours.
Not sure whether this applies to you?
Ask an oncologistWeighing it up
What do you gain, and what does it cost you?
What you gain
- Healthy skin and muscle over an irradiated chest wall
- A reliable blood supply with no microsurgery
- A shorter operation and stay than a DIEP flap
- An option for slim women without spare tummy tissue
What it costs you
- A scar across the back
- Loss of one back muscle, with some change in strength
- Usually an implant as well, with its own long-term care
- A fluid collection under the back wound is common and may need draining
What can go wrong
The most frequent problem is a seroma, a pocket of fluid under the back scar, which may need drawing off with a needle at clinic visits. Less often, part of the flap skin does not heal well. Complete loss of an LD flap is uncommon because its blood supply is never cut.
Who is steered elsewhere
Women with enough tummy tissue and access to a microsurgery team are often offered a DIEP flap instead, to avoid an implant. Women who rely heavily on their arms, and anyone with previous back surgery through the muscle, may be advised against it.
Ask what the fallback would be if a seroma or a wound problem delayed your other treatment.On your plan
Words you will hear, in plain language
- Latissimus dorsi
- The broad, flat muscle across the lower half of the back that pulls the arm down and back. The flap is named after it.
- Pedicled flap
- Tissue moved while still attached to its own blood supply, like a lamp on a cable. No vessels are cut and rejoined.
- Seroma
- A collection of clear fluid under a wound, common at the back after an LD flap. Drawn off with a needle if it is large.
- Extended LD flap
- A version that takes extra fat from around the muscle so a small breast can be made without an implant.
- Animation
- Visible movement of the reconstructed breast when you use the arm, because the muscle still contracts. Usually mild and it settles.
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Did you know
The LD flap is one of the oldest breast reconstruction operations still in regular use, because its blood supply is so dependable. It is often the operation surgeons turn to when a chest wall has been irradiated or an earlier reconstruction has run into trouble.
Commonly believed
Four things families tell us, and what is actually true
"She will not be able to use that arm properly again."
The arm still works. Other shoulder muscles take over most of what the latissimus did. Some women notice less power in pulling down or pushing up, which matters for swimming or a physical job. Physiotherapy helps.
"An LD flap means no implant is needed."
Usually an implant is still needed, because the back tissue is thin. The flap provides skin and cover; the implant provides volume. An extended version can sometimes make a small breast without one. Ask which is planned for you.
"The back scar will be worse than the mastectomy scar."
It is a real scar, but it is placed so a bra strap or the line of a blouse covers it, and it fades over time. Most women find the tightness in the back in the first weeks harder than the scar itself.
"It is a second-rate option compared with a DIEP flap."
It is a different option, not a lesser one. For a slim woman, a woman with previous tummy surgery, or a centre without microsurgery, it is often the sounder choice.
Being straight with you
What this page cannot tell you, and what to ask
This page cannot tell you whether your back tissue is enough, whether you will need an implant with it, or how your chest skin has coped with radiation. Only the surgeon who examines you can judge that.
Questions worth taking to the appointment
Ask whether an implant is planned alongside the flap. Ask where the back scar will sit. Ask how losing the muscle would affect your work or sport, and whether physiotherapy is arranged. Ask how a fluid collection is handled at this centre.
Recovery, honestly
Expect tightness across the back and under the arm for weeks. Lifting, reaching overhead and driving are restricted at first. Someone will need to help at home in the first fortnight, especially with washing and dressing.
On cost and cover
The flap, any implant, the stay and follow-up visits each carry a cost. Aarogyasri, CGHS, ECHS, EHS and cashless insurers treat reconstruction differently, and the implant may be assessed separately. Ask the scheme desk for a written view of the whole pathway.
Bring your radiation summary to the consultation. It is the document most likely to shape which flap is suggested.Questions we are asked
Common questions about LD flap reconstruction
Will I lose strength in my arm or shoulder?
Some, in pulling the arm down and back, but other shoulder muscles take over most of it. Everyday tasks like cooking, lifting a child or carrying shopping usually return after healing. Swimmers and people with heavy physical jobs notice it more.
Can I have an LD flap after radiation?
Yes. This is one of its main uses, because it brings fresh, non-irradiated skin and muscle to cover the chest wall, which an implant alone cannot do. The surgeon will still wait for the radiated skin to settle and examine it before booking.
Why is there fluid collecting in my back?
A seroma, a pocket of clear fluid under the back scar, is the most common problem after this operation. It is not dangerous but can feel like a soft swelling. It is drawn off with a needle at clinic if large, sometimes more than once.
Will the new breast move when I use my arm?
It can, because the muscle still contracts when you pull the arm. This is called animation. For most women it is mild and becomes less noticeable over time. If it bothers you, mention it at follow-up, as there are ways to reduce it.
How long is the hospital stay and recovery?
The stay is longer than for a mastectomy alone, because there are two wounds and drains from the back. Most women are moving within days and home within the week. Back tightness and lifting limits last weeks.
Does the implant with it need replacing later?
Implants are not lifetime devices. Over the years they can harden, shift or leak, and a further operation may be needed. The flap itself, being your own tissue, does not need replacing. Plan for the chance of implant surgery in later years.
Can it be done at the same time as the mastectomy?
Yes, as an immediate reconstruction, if radiation afterwards is unlikely and you are fit for the longer operation. If radiation is likely, many teams prefer to wait so the flap and implant are not exposed to it. Timing is decided with the whole team.
Is an LD flap covered by Aarogyasri or insurance?
Cover varies by scheme and policy, and the flap and the implant may be assessed separately. Do not assume either way. Call the helpline with your card or policy details and we will check what is likely to be accepted before you plan around it.
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- NHS — Mastectomy: Breast reconstruction
- Cancer Research UK — Breast reconstruction
- American Cancer Society — Breast Reconstruction Using Your Own Tissues (Flap Procedures)
- Macmillan Cancer Support — 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.
Keep reading
Related pages
Implant vs Flap Reconstruction: How to ChooseWhere the LD flap sits among the optionsDIEP Flap ReconstructionThe tummy flap it is most often compared withThe Donor Site: What It Costs YouThe back wound and what to expect from itReconstruction After Radiation: What ChangesWhy fresh skin matters over an irradiated chestLiving With an Implant Long TermThe implant that usually comes with it
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Been offered an LD flap and want it explained?
Send us your reports or call the helpline. A surgical oncologist will talk through what the operation would mean for you. One helpline serves every CION centre.