The latissimus dorsi flap uses back muscle and skin to reconstruct the breast after mastectomy. A reliable autologous technique, particularly indicated after radiotherapy, used alone or completed with fat grafting.
The latissimus dorsi flap is an autologous reconstruction technique: it uses your own tissue — muscle and skin harvested from the back — to reconstruct the breast. It is a reliable alternative when thoracic tissue is insufficient or damaged.
The latissimus dorsi muscle is a thin, wide muscle of the back whose function is not essential for everyday activities. It is kept alive through its vascular pedicle and transferred forward through the axilla to the thoracic region.
The flap is placed under the mastectomy skin that has been preserved. It provides high-quality musculocutaneous coverage to protect and wrap an internal implant — or, in some cases, is sufficient on its own to restore volume.
Breast reconstruction does not affect oncological surveillance in any way. The follow-up schedule remains unchanged after surgery.
Breast reconstruction is never mandatory. It remains a personal choice, discussed in consultation without pressure or imposed timelines. An external prosthesis may be satisfactory for some patients. Flat closure is also a fully legitimate option.
The latissimus dorsi flap is not a fallback technique — it is a technique of choice in specific situations where an implant alone is insufficient or exposes the patient to unacceptable risk.
When the remaining thoracic skin is insufficient, tight or damaged by radiation, it cannot adequately protect an implant alone. The dorsal tissue provides the missing coverage.
This is the reference indication. Radiotherapy damages thoracic tissue and significantly increases the risk of capsular contracture around an implant. The dorsal tissue, which has not been irradiated, provides healthy coverage and fundamentally changes the reconstruction prognosis.
In the event of complications with an existing reconstruction (severe capsular contracture, implant exposure, skin necrosis), the latissimus dorsi flap can often rescue the situation and significantly improve the outcome.
Previous abdominal surgery, multiple scars, BMI too low or too high: in these situations, the latissimus dorsi flap remains accessible even when DIEP or TRAM techniques are not possible.
In the context of a prophylactic mastectomy for BRCA mutation or another genetic predisposition, if nipple-areola preservation is not possible and skin coverage is insufficient, the latissimus dorsi flap can complement the reconstruction.
The latissimus dorsi flap can be used alone — when the autologous volume is sufficient — or completed with breast fat grafting to refine and balance the volume. The goal is a fully autologous reconstruction, without any foreign material.
Possible in patients with a naturally modest breast volume and a well-padded back. The flap provides both the skin coverage and sufficient volume to reconstruct the breast without any foreign material.
The main advantage is the absence of any internal implant — no risk of capsular contracture, rupture. The back scar remains the principal drawback.
When the flap volume is insufficient, it is completed with breast fat grafting — injection of autologous fat harvested from the body — in one or more sessions. This is today the preferred strategy, entirely autologous.
Association with an internal implant remains possible in certain specific cases but has become rare. It may be discussed when fat grafting alone would not achieve the desired volume.
Nipple-areola reconstruction and contralateral symmetrisation are systematically proposed in a second stage, once the reconstructed breast volume has stabilised — generally 3 to 6 months after the main procedure. These procedures are also covered by French health insurance.
A pre-operative medical work-up is performed if required, with an anaesthesia consultation no later than 48 hours before the procedure. In all cases, the surgeon reviews contralateral breast imaging — if the last examination is more than one year old, a new assessment is arranged.
Smoking cessation is required at least one month before surgery — smoking significantly increases the risk of wound complications and flap necrosis. E-cigarettes are treated in the same way.
General anaesthesia. Mandatory consultation no later than 48 hours before.
Surgery takes 2 to 3 hours. A hospital stay of several days is required, until the thoracic and dorsal drains are removed. Swimming can be resumed earlier than other sports.
Covered by French health insurance under the ALD scheme for breast cancer. Additional fees apply (Sector 2) — a quote is provided in consultation.
The latissimus dorsi flap immediately restores volume and shape, allowing normal dressing with a neckline. The result is natural — autologous tissue has an appearance and texture close to the natural breast.
2 to 3 months are needed to appreciate the final result, once the tissue has settled and swelling resolved. Some residual asymmetry between the two breasts is inevitable — in volume, shape and height.
Scars — thoracic and dorsal — appear pink and raised in the first months, then gradually fade without ever completely disappearing.
The aim is to achieve a significant improvement, not perfection. With realistic expectations, the result should give you great satisfaction. Medical and family support plays an important role in the months following surgery.
Latissimus dorsi flap reconstruction is a major surgical procedure. Serious complications are fortunately rare when performed by an experienced surgeon. Understanding them allows better anticipation.
The most frequent complication after latissimus dorsi harvest is seroma — a fluid collection that forms in the dorsal cavity left by the muscle. It is more an inconvenience than a true complication.
Depending on its volume, it may resolve spontaneously or require simple aspiration (one or more times) in the outpatient clinic. In rare cases, a persistent fluid pocket requires surgical revision. Drainage at the end of the procedure reduces but does not eliminate this risk.
Simple aspiration if necessary Surgical revision rarely neededSkin undermining carries a risk of tissue ischaemia, related to the fragility of the vascular network. This risk is increased by flap reconstruction when sutures are placed under tension, and is significantly higher in patients who have had radiotherapy or who smoke.
Major necrosis may require surgical revision to remove necrotic tissue and, in extreme cases, may lead to infection and reconstruction failure. Smoking cessation at least one month before surgery is mandatory.
Smoking cessation mandatory ≥ 1 month Risk increased after radiotherapyInfection is a risk inherent to any surgical procedure. It requires antibiotic treatment and, sometimes, surgical drainage. If an implant is associated, infection may lead to its temporary removal.
This risk is higher after radiotherapy and in smokers. Antibiotic prophylaxis is administered systematically intra-operatively.
Systematic antibiotic prophylaxis Risk increased after radiotherapyTemporary shoulder stiffness on the operated side is common in the weeks following surgery. It resolves in the vast majority of cases with physiotherapy and swimming.
High-level athletes practising pulling sports (climbing, competitive swimming, rowing) may notice a slight residual strength asymmetry. This is discussed individually in the pre-operative consultation.
Physiotherapy recommended Swimming encouraged earlyRadiotherapy profoundly alters the quality of thoracic tissue: skin becomes less supple, less vascularised, more fragile. An implant placed under irradiated skin carries a much higher risk of capsular contracture, infection or skin breakdown.
The latissimus dorsi flap, harvested from a non-irradiated area, brings healthy tissue that will protect and envelop the implant — or reconstruct volume on its own. It fundamentally changes the prognosis of reconstruction in this context.
Healthy, non-irradiated tissue Reduces capsular contracture risk Reference technique post-radiotherapyYes, the back scar is unavoidable — it is the main trade-off of this technique. It is most often horizontal, positioned to be concealed under a bra strap. Its orientation is discussed in the consultation based on your morphology and clothing habits.
Scars appear pink and raised in the first post-operative months. Beyond that, they generally fade over time and become minimally visible — without ever completely disappearing. In some cases they may remain somewhat prominent and require specific treatment.
Horizontal scar, concealable Favourable evolution over 12–18 monthsThe latissimus dorsi is a thin muscle whose function is not essential for everyday activities. Its removal rarely causes significant functional impairment in daily life.
Athletes practising pulling or strength disciplines (climbing, competitive swimming, rowing, weight training) may notice a slight strength asymmetry on the operated side. This point is systematically discussed in the pre-operative consultation to tailor the information to your specific physical activity.
Daily life unaffected High-level athletes: to be discussedBreast reconstruction after breast cancer is covered at 100% by French health insurance (Assurance Maladie) on the basis of the standard tariff, under the ALD scheme. This includes the flap, any associated fat grafting, contralateral symmetrisation and nipple-areola reconstruction.
Dr Zeitoun practises in Sector 2 (non-OPTAM). Additional fees apply. A detailed quote is provided before any procedure. Your supplementary health insurance may cover part or all of the additional fees depending on your policy.
100% base rate SS (ALD) Quote provided in consultation Supplementary insurance possibleYes. Latissimus dorsi flap reconstruction can be performed immediately at the time of mastectomy (same anaesthetic), or as a delayed procedure — secondary reconstruction months or years later.
In practice, the latissimus dorsi flap is more commonly used for secondary reconstruction, particularly after radiotherapy — where it is irreplaceable. For immediate reconstruction, a direct implant or expander is often proposed first when conditions allow. The decision is discussed at a multidisciplinary team meeting (MDT).
Immediate or delayed MDT decisionEvery situation is unique. The consultation allows us to define together the technique best suited to your anatomy, your treatments and your expectations.