Breast Reconstruction with a Latissimus Dorsi Flap, Tissue Expander, and Implant
You can find your way back to a balanced breast shape and a fuller sense of being at home in your own body after breast cancer treatment.
Is this right for you?
This approach uses a strip of tissue made up of skin, fat, and the broad muscle of your back below the shoulder blade (its medical name is the latissimus dorsi). That tissue is moved around to the front of the chest to rebuild the breast. Because your own tissue alone is often not enough to create fullness, your surgeon adds a tissue expander (a soft, hollow pouch that is slowly filled with saline over several weeks to stretch the skin) and later an implant. This method suits some situations better than others.
This may be a good fit if
- You have had, or will have, a mastectomy and you would like to rebuild your breast shape
- The skin over your chest is thin, scarce, or has been treated with radiation, so it needs healthy tissue to cover it
- You have enough muscle and tissue in your back to use as a flap, based on your surgeon's assessment
- You understand that the process happens in several stages and you are willing to keep your follow-up appointments for filling the tissue expander
- Your general health allows for a long operation, based on your pre-surgery check-up
This may not be right if
- You are smoking and cannot stop before surgery, because this raises the chance that the flap tissue will not heal
- You rely heavily on your back muscles for your work or sport, because taking muscle can affect the strength of your shoulder and back
- You have a condition that is not yet well controlled, such as diabetes or a bleeding disorder, or you are at a stage of cancer treatment where immediate reconstruction is not advisable
- You are hoping for a complete, finished result from a single operation
How it works
Everything begins with a private consultation. Your surgeon reviews your breast cancer history, your treatment plan (including radiation if you have had it), examines your chest and your back, and then talks with you about the shape and size you have in mind. This is also the time to raise any worries and ask your questions.
The operation is usually done under general anaesthesia, which means you are fully asleep and feel nothing throughout. Your surgeon makes an incision on your back to lift the latissimus dorsi muscle along with the skin and fat above it, keeping the blood vessels that feed the flap intact. This flap is then passed through a tunnel under the skin at your armpit to the front of the chest.
At the chest, your surgeon shapes the tissue to rebuild the breast and places a tissue expander underneath. Over the following weeks, you come back so your surgeon can add more saline to the expander through a small valve, letting the skin and tissue stretch gradually to the volume you want. This happens slowly so the tissue has time to adjust.
At a later operation, usually a few months on, your surgeon removes the tissue expander and replaces it with a fixed implant to settle the fullness and shape. The type of implant, the way it is placed, and any other fine-tuning will depend on your own body.
Realistic expectations
Breast reconstruction aims to restore a balanced breast shape and a fuller sense of being at home in your body, rather than to recreate your natural breast exactly as it was. The reconstructed side may differ from the other in firmness, in how it feels to the touch, and in how it responds to changes in temperature. Understanding this from the start helps you feel more at ease with the result.
What this will not do
- It will not restore normal skin sensation over the reconstructed breast; feeling is usually reduced and may not return fully
- It will not rebuild the areola and nipple on its own; these are separate steps if you want them
- It will not treat breast cancer; this is surgery to restore your shape, separate from treating the disease
- It will not make both breasts identical; your surgeon works toward a balanced, harmonious match within the limits of your tissue and the technique
Recovery
This is a major operation with wounds on both your chest and your back, so your body needs time. Recovery happens in stages, and the pace is different for everyone. The milestones below are rough estimates to help you picture the path, not exact numbers.
- The first few days
- You stay in hospital so the team can watch the flap and manage your pain. You will have drains placed in your chest and back to remove fluid.
- Weeks 1 to 2
- You go home, with limited movement in the arm and shoulder on the side that was operated on. The drains are usually removed once the fluid has dropped enough. Feeling tired, with tightness in your back and chest, is normal.
- Weeks 3 to 6
- You gradually return to light activity and may begin your scheduled tissue expander fills. Avoid lifting heavy objects and any strong movement of the shoulder and back area until your surgeon says it is safe.
- Around 2 to 3 months
- Many people return to work that is not physically demanding, along with everyday activity. The exact timing depends on how strenuous your work is and on how your healing is coming along.
- The implant exchange operation and beyond
- Once the skin has stretched enough, you go through the operation to swap the expander for the implant, followed by a shorter recovery. The final shape settles gradually over several months.
Risks & safety
Every operation carries risk, and this method is no exception. Your surgeon will talk through the points below openly before you decide, so you can weigh them fully.
- The flap may not receive enough blood supply and may heal poorly, in part or in full, though this is uncommon
- Weakness or a change in sensation in the shoulder and back on the side the muscle was taken from, which can last
- Fluid collecting in the back where the flap was taken, sometimes needing to be drained again
- Infection, bleeding, or a collection of blood that needs monitoring or treatment
- With the tissue expander and implant: shifting, the implant showing through, rupture, or capsular contracture (scar tissue tightening around the implant, making the breast feel hard or change shape)
- Scars on both the chest and back, which fade and take shape differently from one person to the next
- Breasts that are not fully even, which may call for further adjustment
How we do it
At The Gioi Dep, the surgeons approach breast reconstruction as a multi-stage journey planned around you. Before surgery, the team carefully assesses your chest, your back, and your cancer treatment history, and works alongside your oncology plan where needed, to choose the sequence that fits your body and what you are hoping for.
During and after surgery, the flap's health and your wound care are watched closely. Tissue expander fills are scheduled to the pace your tissue can take, and there is always someone for you to ask when questions come up during recovery.
Frequently asked questions
Will this surgery hurt
You will be fully asleep during the operation, so you will not feel anything. Afterward, pain and tightness in both the chest and back are common, and the team will use pain relief to keep you more comfortable in those first days.
How long will I need off work
Many people return to work that is not physically demanding within about 2 to 3 months, but this depends on how active your job is and on how quickly you heal. Work that calls for a lot of shoulder and back strength needs a longer break.
What will the scars look like
You will have scars on your chest and one scar on your back where the flap was taken. New scars are usually red and noticeable, then fade over many months to more than a year. How much they fade and the shape they take vary from person to person.
Why are several operations needed
Because the chest skin after a mastectomy is often not enough to hold a full implant straight away. The tissue expander is filled little by little to stretch the tissue over several weeks, and then a separate operation swaps it for a fixed implant. Working in stages this way lets the tissue adjust more safely.
Will the reconstructed breast look and feel natural
Combining your own tissue from the back with an implant often gives a soft, balanced breast shape. Even so, it will feel different to the touch from your other breast, and the reconstructed area usually has less feeling. Your surgeon works toward harmony rather than recreating the old sensation exactly.
Will taking back muscle make me weaker
The latissimus dorsi muscle takes part in pulling and pushing movements of the arm. After part of it is taken, some people notice that shoulder feels weaker or that sensation has changed, and this can last. Rehabilitation exercises help, but if you rely heavily on this muscle group, talk it through carefully with your surgeon.
Am I too old for this
Age is not the only deciding factor. What matters more is your general health and your ability to tolerate a long operation, which is made clear through your pre-surgery check-up. Your surgeon will weigh this with you based on your own situation.
I have had radiation, so can I still have this done
Skin that has had radiation is often thin and heals less well, and this is one of the very reasons this method is considered, since the healthy tissue from your back gives that area better cover. Your surgeon will assess the state of your skin to work out the right path for you.
Are the areola and nipple reconstructed at the same time
Usually not. Rebuilding the nipple and shaping the areola are separate steps, done after the breast shape has settled, if you want them. You can discuss this option with your surgeon when you reach the right stage.
How long until I see the final result
The breast shape keeps changing through several stages, from the expander fills, to the implant exchange, and then settling gradually over the months after. Give your body time before you judge the final result.
The next step
The next step is a conversation - book a consultation.
The content on this page is for reference only and does not replace a direct examination and consultation with a specialist physician. Surgical outcomes vary from person to person.