latissimus dorsi flap: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drcosmetic

Definition (What it is) of latissimus dorsi flap

A latissimus dorsi flap is a surgical technique that moves tissue from the upper back to another area of the body.
It commonly includes skin, fat, and sometimes part of the latissimus dorsi muscle, carried on its blood supply.
It is widely used in reconstructive surgery, especially breast reconstruction, and may also be used in other soft-tissue repairs.
In select situations, it can support cosmetic goals such as restoring contour or symmetry after previous surgery or injury.

Why latissimus dorsi flap used (Purpose / benefits)

The main purpose of a latissimus dorsi flap is to restore missing or damaged soft tissue with living tissue that has a reliable blood supply. In reconstructive settings, this can help replace volume, improve contour, and provide healthy tissue coverage over areas where skin and soft tissue are thin, scarred, or previously treated.

In breast reconstruction, the flap can help recreate breast shape after mastectomy or address complex revision needs (for example, after implant problems, radiation-related tissue changes, or previous reconstruction). In other parts of the body, it can provide coverage for wounds or defects where a durable layer of tissue is needed.

Potential benefits (which vary by clinician and case) include:

Volume and shape restoration where tissue is missing
Improved soft-tissue coverage over implants, ribs, or other structures
Bringing healthier tissue into areas affected by scarring or reduced tissue quality
Flexibility: can be used alone or combined with an implant or fat grafting in breast reconstruction
Reconstructive reliability because the flap is typically transferred with a known, consistent blood vessel supply

Indications (When clinicians use it)

Typical scenarios include:

Breast reconstruction after mastectomy (immediate or delayed)
Breast reconstruction or revision in patients with thin, scarred, or lower-quality chest tissue (including after radiation)
Salvage or revision cases after complications with implants or previous reconstructions (varies by clinician and case)
Reconstruction of soft-tissue defects of the chest wall, back, shoulder, or upper arm region
Coverage of exposed implants or hardware in selected reconstructive situations
Complex wound coverage when local tissue is insufficient or unreliable
Selected head-and-neck or upper torso reconstructions where a well-vascularized flap is needed

Contraindications / when it’s NOT ideal

A latissimus dorsi flap may be less suitable when:

The latissimus dorsi muscle or its blood supply has been significantly injured or disrupted by prior surgery, trauma, or scarring (varies by clinician and case)
The patient cannot tolerate a longer surgery or anesthesia due to significant medical comorbidities (decision-making is individualized)
The back donor site does not have adequate tissue for the reconstructive goal, or the required volume is high and another flap may match better
There is active infection or uncontrolled wound problems in either the donor or recipient area (timing and approach vary by clinician and case)
Significant shoulder dysfunction exists and preserving back/shoulder strength is a priority (risk-benefit assessment varies)
Another approach may provide better match for the needed volume, shape, or long-term goals (for example, an abdominal-based free flap in breast reconstruction, when appropriate)
Patient preference does not align with the trade-offs (donor-site scar, drains, recovery profile, or potential functional impact)

How latissimus dorsi flap works (Technique / mechanism)

A latissimus dorsi flap is a surgical procedure (not minimally invasive and not non-surgical). Its mechanism is repositioning living tissue from the upper back to a new location to restore volume, cover a defect, and improve contour.

High-level mechanism:

Restore volume and contour by transferring skin/fat with or without muscle
Improve tissue quality and coverage by bringing in healthy, well-perfused tissue
In breast reconstruction, it may be used with an implant or tissue expander to achieve desired size, or without an implant if sufficient volume is available (varies by anatomy and technique)

Typical tools/modalities:

Incisions on the back (donor site) and at the reconstruction site (recipient site)
Surgical dissection to mobilize the flap while preserving its blood supply (commonly the thoracodorsal vessels in pedicled techniques)
Tunneling or transfer of the flap to the recipient area (pedicled transfer is common; free transfer is less common and depends on case)
Sutures for shaping, securing the flap, and closing incisions
Drains are commonly used to manage fluid accumulation in the early healing period (usage varies by surgeon)
Implant or tissue expander may be placed in some breast reconstructions; energy-based devices and injectables are not the primary mechanism for this procedure

latissimus dorsi flap Procedure overview (How it’s performed)

Below is a general workflow; exact steps vary by clinician and case.

Consultation – Discussion of goals (reconstructive and/or cosmetic), prior surgeries, medical history, and expectations.
Assessment and planning – Examination of the back (donor tissue availability, scar position options) and the recipient site (skin quality, scarring, volume needs). – Planning for whether an implant/tissue expander may be used (common in some breast reconstructions).
Preparation and anesthesia – The procedure is typically performed under general anesthesia; anesthesia choices depend on the surgical plan and patient factors.
Procedure – Donor-site incision is made on the back, and the flap is elevated while preserving blood supply. – The flap is transferred to the reconstruction area (often pedicled) and shaped to meet the reconstructive goal. – If planned, an implant or expander may be placed to add volume.
Closure and dressing – Surgical sites are closed with sutures, and dressings are applied. – Drains may be placed to reduce early fluid collection risk.
Recovery – Early recovery focuses on wound healing, monitoring flap viability, managing swelling, and gradually returning to routine activity based on the clinician’s protocol.

Types / variations

Common variations are based on how the flap is designed and how it is transferred:

Pedicled latissimus dorsi flap
The flap remains attached to its original blood supply and is rotated/tunneled to the recipient area.
This is a commonly described approach in breast reconstruction.
Free latissimus dorsi flap
The tissue is completely detached and reconnected to blood vessels at the recipient site using microsurgery.
Used less commonly for breast reconstruction than pedicled approaches, and more selectively depending on defect location and reconstructive goals.
Muscle-including vs muscle-sparing approaches
Some techniques include more of the latissimus dorsi muscle; others aim to preserve muscle where possible (terminology and feasibility vary by surgeon and case).
Extended latissimus dorsi flap
Designed to recruit more surrounding fat/skin to increase volume.
Often discussed when the goal is more volume without relying entirely on an implant (results vary by anatomy).
Implant-assisted vs autologous-only reconstruction (breast)
Implant-assisted: flap provides healthy coverage and contour, implant provides additional volume.
Autologous-only: flap alone is used for volume and shape when tissue allows (varies by body type and goals).
Anesthesia variations
Typically general anesthesia; choices depend on operative extent, patient factors, and facility protocols.

Pros and cons of latissimus dorsi flap

Pros:

Uses living tissue with its own blood supply, which can be helpful in scarred or lower-quality recipient sites
Can improve soft-tissue coverage and contour, especially when the skin envelope is thin
Often adaptable for revision/salvage reconstruction scenarios (varies by clinician and case)
Can be combined with an implant or expander when additional volume is needed
Donor tissue is located on the back, which may be acceptable for some patients depending on scar placement
Can be applied to multiple reconstructive problems beyond the breast (selected chest wall and upper-torso defects)

Cons:

Creates a donor-site scar on the back and an additional surgical site to heal
Risk of fluid collection (seroma) at the donor site is a commonly discussed issue (risk varies)
May cause temporary or persistent shoulder/back weakness or fatigue, depending on how much muscle is used and individual recovery
Often involves drains and a recovery period that can feel more involved than smaller procedures
In breast reconstruction, may still require an implant to achieve desired size in some body types (varies)
As with any surgery, there are risks such as infection, bleeding, wound healing problems, scarring, and the possibility of additional procedures (risk varies by patient and case)

Aftercare & longevity

Aftercare for a latissimus dorsi flap typically focuses on supporting healing at both the donor site (back) and the recipient site (such as the breast). The specifics—dressings, drain management, activity limits, and follow-up schedule—are individualized and provided by the surgical team.

General factors that can influence durability and long-term appearance include:

Surgical technique and flap design, including how the tissue is shaped and secured
Tissue quality at the recipient site (for example, scarring or radiation-related changes can affect healing and long-term softness)
Body weight changes over time, since transferred fat can change with overall weight
Scarring tendencies, which vary widely among individuals
Lifestyle factors that influence wound healing and skin quality (for example, smoking history and sun exposure for scars)
Rehabilitation and movement patterns, especially for shoulder function after using back tissue (approach varies by clinician)
Implant factors if an implant/expander is used (longevity, monitoring needs, and future revision considerations vary by material and manufacturer)

In many reconstructive contexts, the flap tissue itself is intended to be long-lasting; however, appearance and symmetry can change over time due to normal aging, weight fluctuation, and changes in the opposite breast or surrounding tissues. Some patients undergo later revision procedures (for contour, scar refinement, or symmetry), but whether that is needed varies by clinician and case.

Alternatives / comparisons

The most appropriate alternative depends on the clinical problem being treated (breast reconstruction vs wound coverage vs contour restoration), available donor tissue, prior surgeries, and patient preference. Common comparisons include:

Abdominal-based free flaps (e.g., DIEP flap, muscle-sparing TRAM flap)
Often used in breast reconstruction to provide larger volume using lower-abdominal tissue.
Typically require microsurgery and may have a different donor-site profile than a back-based flap.
Compared with latissimus dorsi flap, these may provide more volume without an implant in many patients, but complexity and candidacy vary.
Implant-based reconstruction without a flap
Uses an implant or expander to create breast shape.
May involve fewer donor-site concerns, but relies on the quality of the chest skin/soft tissue.
In patients with thinner tissues or prior radiation, some surgeons consider adding a flap (like latissimus dorsi flap) to improve coverage (varies by clinician and case).
Fat grafting (autologous fat transfer)
Uses liposuctioned fat placed to restore volume and contour.
Often used as an adjunct for refinement rather than a full replacement for missing tissue in larger defects (varies by case).
Compared with a flap, fat grafting does not transfer a dedicated blood supply as a single tissue unit and may require multiple sessions.
Other local or regional flaps
Depending on defect location, smaller nearby flaps can sometimes cover wounds or improve contour.
These may reduce donor-site impact compared with larger flaps but may offer less tissue or less robust coverage.
Other free flaps from different donor sites
Thigh- or buttock-based options may be considered when abdominal tissue is not available or suitable.
These are more specialized and vary by center expertise and patient anatomy.
Non-surgical options
For true tissue loss or reconstructive needs, non-surgical treatments generally cannot replace missing volume and coverage in the way a flap can.
Non-surgical modalities may play a role in scar management or skin quality support in some contexts, but they are not substitutes for flap reconstruction.

Common questions (FAQ) of latissimus dorsi flap

Q: Is a latissimus dorsi flap painful?
Some discomfort is expected after surgery, particularly at the back donor site and the recipient site. Pain experience and control strategies vary by clinician and case. Many patients describe tightness, pulling, or soreness early on that improves as healing progresses.

Q: What kind of anesthesia is used?
It is typically performed under general anesthesia because it involves tissue transfer and work at more than one surgical site. The exact anesthesia plan depends on the extent of reconstruction and patient-specific factors.

Q: Will I have scars, and where are they?
Yes. There is usually a scar on the upper back where the tissue is taken and a scar at the reconstruction site (for example, the breast). Scar length and placement vary by technique, anatomy, and prior incisions.

Q: How long is the downtime and recovery?
Recovery varies by clinician and case, including whether an implant is placed and whether the surgery is immediate or delayed reconstruction. Many people need a period of limited activity while incisions heal and swelling decreases. Return to work and exercise depends on job demands and the surgical team’s protocol.

Q: How long does the reconstruction last?
The transferred tissue is living tissue and is generally intended to provide durable coverage and contour. However, shape and symmetry can change over time with aging, weight changes, and healing patterns. If an implant is used, implant longevity and follow-up needs vary by material and manufacturer.

Q: Is latissimus dorsi flap considered “safe”?
All surgeries have risks, and safety depends on patient health, surgical complexity, and the treating team’s experience. A latissimus dorsi flap is a well-established reconstructive option, but complications can occur, including donor-site fluid collections, wound healing issues, or the need for additional procedures.

Q: Will the procedure affect shoulder strength or movement?
It can. Because the latissimus dorsi is involved in certain shoulder movements, some patients notice weakness, tightness, or fatigue, especially early on. The degree and duration of functional change vary based on how much muscle is used, baseline fitness, rehabilitation approach, and individual healing.

Q: What is the typical cost range?
Costs vary widely by country, facility, surgeon, anesthesia, hospital stay, and whether the surgery is reconstructive or cosmetic. Additional factors include implants/expanders, imaging, pathology (when relevant), and revision procedures. For accurate estimates, clinics typically provide itemized quotes after an assessment.

Q: Can a latissimus dorsi flap be used after radiation therapy?
It is sometimes used in patients who have had radiation because it can bring healthier tissue into an area where skin and soft tissue may be tighter or less elastic. Suitability depends on the timing of radiation, tissue condition, and the overall reconstructive plan. Decisions are individualized and vary by clinician and case.

Q: Does it always require an implant for breast reconstruction?
Not always. Some techniques aim to create enough volume using the flap tissue alone, while others commonly pair the flap with an implant or expander to reach the desired size. The need for an implant depends largely on body type, tissue availability, and reconstructive goals.