Reconstruction Using Back Tissue

When back tissue is used for breast reconstruction, it involves the latissimus dorsi muscle, along with the skin and fat that covers the muscle. This procedure is called a latissimus dorsi (LD) flap. The tissue from your back is removed and moved to the front of your chest, with the arteries and veins still attached. Since most women do not have enough fatty tissue on their back to recreate a breast using only the LD flap, an implant or tissue expander is commonly used.

Latissimus Dorsi Myocutaneous (LD) Flap

The location of the incision on your back will depend on the amount of skin needed to replace the skin removed during the mastectomy. Often, the incision can be placed so that your bra will hide the scar. The back tissue that is rotated to the chest will result in a bulky area underneath the armpit. This will decrease over time but may never disappear.

Often, an additional surgery is necessary to replace the tissue expander that is placed under the LD flap for a permanent silicone or saline implant. The LD flap may also be used after breast conservation surgery to fill in the misshapen area that can result after removal of breast tissue. Patients generally have no major long-term problems from the LD flap, and can resume activities of daily living and exercise just as before the surgery.

Advantages of LD flap reconstruction:

• Decreased surgery and recovery time
• Better coverage over the implant
• One-time surgery, if the implant placed immediately
• Good option for thin patients who have had radiation therapy

Disadvantages of LD flap reconstruction:

• A breast implant is usually required for the desired projection and size
• May have complications in the back where the tissue was taken from
• Muscle weakness in the back can affect rock climbers, swimmers and tennis players