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LD Flap Breast Reconstruction

This natural tissue breast reconstruction option uses skin and muscle from the upper back to restore breast contour.


The LD flap moves the LD muscle and skin from the back to the chest to create a breast. It is typically a pedicled flap, which means that the blood supply moves with the flap.

lat flap

© Image Credit

LD muscle with overlying skin brought around from the back to reconstruct the breast (upper 3 images). Back donor site is repaired, flap skin replaces missing nipple areola, and nipple can be reconstructed at second stage (lower 3 images).

It can provide enough tissue for complete breast reconstruction in women with small breasts or men who have undergone mastectomy for the treatment of breast cancer. However, it is most frequently used in hybrid breast reconstruction where an expander for implant is placed beneath the flap. The implant increases volume while the flap creates a more natural looking and feeling breast than would be possible with an implant alone. This flap can also help surgeons salvage a previously failed breast reconstruction or improve breast contour after lumpectomy and radiation.

Types of LD Flap Breast Reconstruction Procedures

Pedicled LD Flap with A Breast Implant

The LD flap is transferred to the chest and secured over a breast implant. This is the most common approach.

Pedicled LD Flap with A Tissue Expander

The LD flap is transferred to the chest and placed over a tissue expander implant. This approach serves patients looking for a larger breast volume. The final implant is placed at a later stage, after the expander is filled sufficiently.

Pedicled LD Flap Alone

The flap is placed alone, without an implant, in patients who want or need a small reconstruction.

Pedicled LD Free Flap

The flap blood vessels are detached and reattached to blood vessels in the chest. This approach is rarely used.

Procedure details:

  • A flap of skin and fat from the back is elevated with the LD muscle
  • The tissue is tunneled underneath the skin beneath the armpit, transferring it to the chest
  • Surgeons close the donor site and reposition the patient onto their back
  • The tissue is used to create a breast shape either on its own or over an implant

Risks & Benefits

Competitive athletes should know that LD flap breast reconstruction can cause some weakening of the shoulder extension and adduction. This potential weakening does not affect activities of daily living.

This flap is particularly beneficial for male patients who have had their pectoralis muscle removed, those who are looking to salvage a failed reconstruction or manage the effects of radiation, and people who would like to make an implant breast reconstruction feel more natural.