Latissimus dorsi myocutaneous flap

Last revised by Dr Yuranga Weerakkody on 19 Mar 2021

A latissimus dorsi myocutaneous flap is a form of breast reconstruction that transplants the patient’s own latissimus dorsi muscle, fat, and skin from the middle back to the chest to form a breast mound.

This flap is more easily created and contains a robust vascular supply compared to other flaps such as transverse rectus abdominis musculocutaneous (TRAM) flap or deep inferior epigastric perforator (DIEP) flap reconstruction. Therefore, it is commonly used if a previous flap has failed 1

A latissimus dorsi flap also causes less patient morbidity as it does not weaken the abdominal wall.

A latissimus dorsi myocutaneous flap produces a less pleasing aesthetic result when compared to transverse rectus abdominis musculocutaneous and deep inferior epigastric perforator flap reconstructions. It commonly requires an implant to achieve symmetry or a pleasing aesthetic result.

It leaves a large scar in the middle of the back and commonly is complicated by a postoperative seroma.

It causes a temporary 15-20% reduction in shoulder strength 2.

Rotated and tunnelled latissimus dorsi muscle gives a tailed appearance to the reconstruction 2.

The denuded dermal layer is seen parallel to the skin of the breast.

  • postoperative seroma at donor site. Some report upwards of >95% of patients developing a postoperative seroma 3.
  • postoperative wound infection
  • postoperative hematoma
  • wound dehiscence
  • flap necrosis
  • chronic back pain
  • DIEP (deep inferior epigastric perforator) flap
  • TRAM (transverse rectus abdominis musculocutaneous) flap

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