Breast Reconstruction with Expander and Latissimus Dorsi Flap 

Reconstruction Using a Tissue Expander Combined With a Latissimus Dorsi Flap

When the tissues of the chest wall are insufficient to provide reliable coverage for a tissue expander or implant, a latissimus dorsi flap (LD flap) can be used. The flap is transferred from the back to the anterior chest wall, supplying additional soft tissue coverage.

This approach makes breast reconstruction possible in situations where implant-based reconstruction alone would be unreliable, such as in patients with thin skin, scarred tissues, or previous radiotherapy.

Indications

• Insufficient soft tissue coverage after mastectomy
• Scarred or fibrotic tissues of the chest wall
• Previous radiotherapy, when implant-only reconstruction is unsuitable and abdominal tissue is insufficient for autologous reconstruction
• The need for additional volume in patients with small breast size

Surgical Technique

The surgeon harvests a skin and muscle flap based on the latissimus dorsi muscle while preserving its native blood supply. The flap is tunneled through the axillary region and transferred to the chest wall without dividing the vascular pedicle.

The transferred tissue creates a well-vascularized envelope that can accommodate either a tissue expander or a permanent implant.

The donor site on the back is closed primarily, leaving a scar that is generally concealed beneath the bra line.

The procedure usually takes between two and a half and four hours, and hospitalization typically lasts five to seven days.

Donor Site Considerations

The scar on the back is usually positioned horizontally within the bra strap line and is therefore well concealed by underwear.

In most patients, shoulder and arm function remains essentially unchanged because other muscles compensate for the loss of the latissimus dorsi muscle.

Patients involved in sports requiring strong shoulder extension and adduction, such as swimming, rowing, climbing, or tennis, may experience a mild reduction in strength. This issue is discussed individually during consultation.

Recovery

Hospitalization generally lasts five to seven days.

Heavy lifting and strenuous use of the shoulder girdle should be avoided for approximately six weeks.

Most patients return to work within three to four weeks.

If a tissue expander is used, gradual expansion follows over a period of three to six months, after which a second-stage procedure is performed to replace the expander with a permanent implant.

Contraindications

• Previous surgery that has damaged or divided the vascular pedicle supplying the latissimus dorsi flap
• Severe systemic diseases that increase surgical risk

Smoking significantly increases the risk of wound-healing problems and donor-site complications and is strongly discouraged.

Frequently Asked Questions

Will the Scar on My Back Be Noticeable?

The scar is positioned horizontally along the bra line and is usually well hidden by underwear or swimwear.

Over time, it generally becomes lighter and less conspicuous.

Will My Arm Become Weaker After Surgery?

For most patients, shoulder function remains normal because surrounding muscles compensate for the removed muscle.

A slight reduction in strength during highly demanding activities is possible but relatively uncommon.

Is This Better Than Reconstruction With an Implant Alone?

When soft tissue coverage is inadequate, combining an LD flap with an expander or implant provides more reliable coverage and reduces the risk of complications.

If sufficient soft tissue is already present, adding a flap may not be necessary.

Book a Consultation

Book a consultation. The surgeon will assess the condition of your tissues and recommend the most appropriate reconstructive strategy for your individual situation.