Latissimus Dorsi Flap

About the Procedure

If you have a mastectomy to treat or prevent cancer, breast reconstruction can surgically recreate a natural-looking breast. One option for breast reconstruction is a latissimus dorsi flap procedure.

The latissimus dorsi is a long muscle that runs beneath the armpit and diagonally across the back. In a latissimus dorsi flap, the surgeon transfers latissimus muscle and fat along with a small amount of back skin to the mastectomy area. The transfer of tissue leaves a five- to seven-inch scar on the back.

Because of the muscle's proximity to the chest, latissimus dorsi flap for breast reconstruction after mastectomy is a popular technique. In addition, the transferred tissue can remain attached to its natural blood supply, making the procedure less complicated than other flap procedures.

The latissimus dorsi flap can be used for breast reconstruction with or without a saline or silicone breast implant. If an implant is going to be used, a temporary tissue expander is often placed under the transferred tissue. After the device is in place, fluid is periodically injected into the expander. This allows the muscle and tissue to stretch and accommodate a permanent implant while also producing a more natural appearance.

Breast Reconstruction at Massachusetts General Hospital

Our plastic surgeons have extensive experience in all types of breast reconstructive techniques, including the newest and most innovative procedures. When appropriate, we combine techniques, using flaps, implants and nipple tattooing to achieve the most natural-looking outcome.

All forms of breast reconstruction after mastectomy have inherent risks, which will be fully discussed during your consultation.

Qualities of Candidates

You may be a good candidate for latissimus dorsi flap reconstruction if you:

• Are thin with smaller breasts
• Have had radiation before and are having an implant inserted
• Have sufficient tissues in your latissimus dorsi to create one or both breasts
• Prefer to reconstruct one or both breasts using your own tissue

You may not be a good candidate for latissimus dorsi flap reconstruction if you:

• Have had surgery on your chest wall, which would preclude the use of the flap
• Prefer not to have a scar on your upper back
• Take part in skiing, swimming or other sports that put excessive stress on the latissimus dorsi area

Other Reconstruction Options

Depending on your particular situation, other flap options to create the new breast may include:

• Deep inferior epigastric perforator (DIEP) flap: Uses tissue from the lower abdomen
• Superficial inferior epigastric artery (SIEA) flap: Uses tissue from the lower abdomen
• Superior or inferior gluteal artery perforator (SGAP/IGAP) flap: Uses tissue from the buttocks
• Transverse rectus abdominus myocutaneous (TRAM) flap: Uses tissue from the lower abdomen
• Transverse upper gracilis (TUG) flap: Uses tissue from the inner thigh and underlying gracilis muscle

The TUG flap and SGAP/IGAP flaps are generally used with patients who lack enough abdominal tissue for the TRAM, DIEP or SIEA flap.