What is Latissimus Dorsi Flap Breast Reconstruction?

This leaflet is for patients who have chosen to consider breast reconstruction at the same time as, or following a mastectomy. This leaflet will guide you through your surgery, and explain the following.

• How you should prepare for the procedure.

• What the risks are to having this procedure.

• How you can expect to feel afterwards.

We hope it will help to answer some of the questions you may have. If you have any further questions or concerns, please speak to the breast care nurses.

What is latissimus dorsi flap breast reconstruction?

The latissimus dorsi muscle is a large muscle that lies in the back, just below the shoulder blade. During this procedure:

• The skin, fat, and latissimus dorsi muscle are removed from the back.

• The blood vessels of the flap, remain attached to the body at the end nearest the armpit (pedicled flap).

• The flap is then brought round to the front of the body to lie over the chest wall. This will form the new breast (or part of the breast, if being used in breast-conserving surgery).

Some of the skin on the flap is used to form the new skin of the reconstructed breast. The muscle and the fat are used to form the volume of the breast. It may be necessary to use an implant under the flap after a mastectomy. This will help create a breast that is a similar size to the other one.

Will I have to stay in hospital?

Yes, you will need to stay in hospital for between 5 and 7 days. The procedure usually takes between 4 and 6 hours.

Are there any alternatives?

You may have alternatives available to you. However, one type of operation may be more suitable for you depending on:

• your shape and build;

• your general health;

• your expectations; and

• whether you are having or have had radiotherapy treatment to the breast or chest wall.

If you have any questions about alternative treatments. please speak to your surgeon or breast care nurse.

Is there anything I can do before I come into hospital to improve my recovery?

Yes.

• Stay calm and positive.

• It would be wise to arrange some help with cooking and housework when you come home.

• If you have small children, arrange a few treats with other people they love, both during your stay in hospital and afterwards. You will need plenty of rest after your surgery.

• If you smoke, it is very important that you try hard to give up before your surgery. For free, friendly, advice and support, contact One You Kent on 0300 123 1220, or via email.

How can I prepare for my surgery?

While you wait for your surgery date, you can start preparing for your operation. Research shows that fitter patients, who are able to improve their health and activity levels before surgery, recover more quickly. Taking an active role in planning and preparing for your operation will help you:

• feel in control

• leave hospital sooner, and

• get back to normal more quickly.

To help with this, you may be contacted by a member of the One You Kent (OYK) team. OYK work in the community, and help patients improve their general health. This includes help and advice on:

• Stopping smoking

• Losing weight

• Getting more exercise

More information can be found on the following web sites.

• One You Kent (Kent Community Health)

• Fitter Better Sooner Toolkit (Royal College of Anaesthetists)

What will happen when I arrive at hospital?

A member of staff will greet you when you arrive at the hospital. They will discuss with you the care you will receive before your operation.

You will see your breast reconstruction surgeon before surgery. They will ask you to sign a consent form. Please use this time to ask any last minute questions.

Why do I need to sign a consent form?

All patients must give permission before they receive any type of medical treatment, test, or examination. Consent is usually given when you sign the consent form before your treatment, but we may ask you to give it verbally.

• You must give your consent voluntarily.

• The hospital must give you all the information you need to make a decision about your treatment. This is so you can give us informed consent.  If you have not been given this information, or you have but you still have questions, please speak to a member of staff. 

• You must be capable of giving consent. This means that you understand the information given to you and can make an informed decision.

When we ask you to give consent, please use this time to ask any questions you may still have. For more information, please go to the NHS Consent for Treatment web page. Remember, you can withdraw your consent for treatment at any time.

Who will perform my operation?

Your breast reconstruction surgeon will perform the operation.

Will I have an anaesthetic?

Yes, you will have a general anaesthetic (you will be asleep).

Before your operation you must not:

• eat food or chew gum for at least 6 hours; or

• drink fluids for 4 hours.

You will meet the anaesthetist before your operation.

Will I need more procedures?

It is not common to need a blood transfusion after this operation; but this may happen. If you have strong views or religious beliefs about this, please speak to your surgeon before your surgery.

If you have a low blood count (anaemia) after your operation, we will prescribe you a course of iron tablets. Your GP may repeat this test after you are discharged from hospital.

Are there any risks to having the procedure?

All surgical and anaesthetic procedures carry some uncertainty and risks. The following list gives you information on the most common risks that can happen following this type of surgery. It is unlikely that you will experience all of them. Most patients recover from the operation without any major discomfort.

• Haematoma is a collection of blood underneath the skin, which may happen after surgery. We try to prevent this by placing small drainage tubes in the wound area. These tubes allow the blood and fluid to drain into vacuumed bottles. Sometimes blood still collects and the breast may become painful and swollen. You may need a second operation to remove the haematoma.

• Seroma. After we remove the drains, serous fluid (a pale yellow, transparent fluid) may collect behind the breast or back wound. Usually this is only a small amount and the body slowly reabsorbs the fluid over a few weeks. Occasionally a larger amount of fluid collects, which is drained in Outpatients. Patients may need to have this done more than once.

• Your surgeon may decide to use an expander implant. You will be able to feel the port.

• A wound infection can happen after any surgical procedure. We may treat the infection with antibiotics, and if necessary further dressings. After an infection the scars may not be quite as neat.

• Any major operation with a general anaesthetic carries a small risk of a chest infection. This happens more with people who smoke.

• Deep vein thrombosis (DVT) is a blood clot in the legs. This is a possible complication following surgery and bed rest. People who are at greater risk are those who:

  • take the oral contraceptive pill or hormone replacement therapy (HRT); and

  • those who smoke.

  Occasionally clots can break off and pass to the lungs, known as a pulmonary embolus (PE). We will give you compression socks before surgery to try to prevent this. You will also have heparin injections in your abdomen each day after your operation. To reduce the risk of developing a PE, you should also do deep breathing and leg exercises. Sometimes you will continue to have heparin injections at home for a short time.

• Poor blood supply to the area, poor nutrition, and / or infection can delay wound healing. Sometimes the wound may break down. This is where the stitches come apart and the wound opens. If this happens you will need:

  • a longer hospital stay;

  • more hospital visits to have your wound(s) checked; and

  • possibly further surgery.

  Smoking increases these risks, as it can have an adverse effect on the healing of all surgical wounds. Eating a healthy diet helps good wound healing. More information is available on the NHS 5 A Day: what counts? web site.

• Some patients may have shoulder stiffness. They may also have restricted movement for activities needing them to use of their arm above 90⁰, for example swimming or tennis.

• Any operation will leave a permanent scar. Infection can cause a wound to re-open. This may lead to problems with scar formation, for example the scar may stretch or thicken. At first, even without a healing problem, the scar will look red, slightly lumpy, and raised. Some people may be more likely to develop keloid or hypertrophic scars, which are raised, itchy, and red. If you are one of these people, please discuss this with your surgeon. In most cases scars settle to become less noticeable.

• Numbness is normal and may be permanent in your new breast and / or back area.

• We will make every effort to make your breasts equal in size and shape. However, you may find that there is a difference between the two breasts. This is quite normal, but if you have any concerns or questions, please talk to your surgeon.

  You may need revision surgery to improve the look of your breasts. Occasionally there is an area of excess breast tissue on the outer part of your breast. This is completely harmless, but may be irritating as it catches when moving your arm. It is known as a ‘dog ear’. We can remove this with another operation.

• There is a small chance that the flap or part of the flap may die if it does not get enough blood supply. This is rare, and is most likely to happen within the first 24 to 48 hours after the operation. If this does happen you will need another operation to remove the affected area. Your surgeon will also discuss with you other reconstruction options that are available.

• Fat necrosis is an uncommon benign (not harmful) condition. This is where fat cells in the breast become damaged and delay wound healing. It is usually painless and the body repairs the tissue over a few weeks. Occasionally the fatty tissue swells and becomes painful. The fat cells may die and their contents form a collection of greasy fluid. This fluid will drain to the skin surface (skin necrosis, when the skin turns black and may form a scab). The remaining tissue may become hard. In severe cases the skin may die. It is very rare that patients need further surgery.

• Psychological aspects. Most patients are pleased with the results of their surgery. However, some patients feel very anxious about their treatment or have difficulty coming to terms with their new look. Their breasts may not be as they had imagined they would be or they may have a complication. If you are worried about your treatment or feel depressed, please speak to your breast care nurse. For more information about our counselling service, please speak to the breast care nurses.

• Sexual activities. To start with, your breasts will feel tender and you may not feel up to physical contact. However, you may restart your sex life as soon as you feel comfortable. You may feel that your partner hesitates to touch you, and this makes you feel less attractive. The most likely reason for this though, is that your partner is afraid to hurt you. Couples may wish to talk over their fears and feelings with their breast care nurse or counsellor.

What happens after my operation?

• Once you return to the ward you can have visitors. In the meantime, with your permission, they can call the ward to find out how you are.

• The nurses will look at and touch your flap (new breast) to check the warmth, colour, sensation, tightness, and blood flow. To begin with, it is very important to keep your new breast warm.

• During surgery your surgeon will have inserted wound drains into your breast(s) and the donor site. These drains allow any collected fluid to drain away. The drainage tube is attached to a vacuum bag, which measures the fluid. Your surgeon will tell the nurses when they can remove your wound drains. This is usually 2 to 7 days after surgery, and depends on the amount and colour of the fluid drained.

• After the nurse removes the drain, it is common to have a small amount of leakage from your wound. You can use a light gauze pad to absorb this. A wound dressing will be in place and changed according to daily checks by your doctors and nurses.

• You will have a urinary catheter, which will be removed on your surgeon’s instruction. This is usually 2 to 3 days after surgery.

• You can have a shower on the ward depending on the type of dressing you have; the nursing staff will be able to advise you.

Will I be in any pain?

When you wake up after surgery, you will be in the recovery area. The nursing staff will make sure that your recovery is as pain-free as possible. The pain from this sort of operation is not usually severe. Different patients need different amounts of pain relief.

For the first 24 to 48 hours, to help with pain relief you will have a morphine pump controlled by you. We will give you painkillers on a regular basis, for as long as you need them. Please tell the nurses if your pain continues.

What happens after I am discharged from hospital?

• We will send you home with a waterproof dressing on your wound. You can shower with the dressing on, but do not soak in the bath.

• Please take painkillers as needed.

What should I do when I get home?

Most patients return to their normal light activities 2 to 4 weeks after surgery. However, this will vary from person to person. Build up gradually to more strenuous tasks, such as housework or gardening.

You may need to ask someone to help you for the first couple of days. It is important that you get plenty of rest and you set aside time during the day for this. Do not be afraid to take some ‘time out’ for yourself, to rest your mind and body.

Can I wear a bra after surgery?

Yes, you will need to wear a special reconstruction bra, as advised by your surgeon. Please wear this bra for up to 3 months, for 23 out of 24 hours a day (including night time). Only remove the bra for showering / washing.

The bra helps support the underlying tissue and suture (stitch) lines while they heal. Your breast care nurse will be able to measure you and make sure that the bra is comfortable for you.

When can I start driving again?

You will not be able to drive immediately after your operation. Only start driving when you have healed enough to wear a seat belt without pain. This is usually 4 to 6 weeks after surgery.

Before driving again, speak to your insurance company. Make sure that you have the appropriate insurance cover. Some companies ban driving for a specific period following surgery. Not following this instruction would mean you were driving without insurance, which is a serious offence.

When can I return to work?

Depending on the type of work that you do, you may be able to return to work within 2 to 3 months. You may feel tired at first. This is normal. Talk to your employer about a gradual return to work.

When can I start my normal sports activities again?

You can start most sports within a few of weeks of surgery, but check with your surgeon or breast care nurse first. If the sport involves strenuous upper body movements, start these activities gradually at least 6 weeks after your surgery. This include aerobics, golf, swimming, and any racquet sports.

It is important that you continue to carry out the exercises given to you by your physiotherapist/ breast care nurse. Start other activities slowly.

Will I need a follow-up appointment?

Yes. We will make an appointment for you to see your breast surgeon a week after leaving hospital. We will give you details of this appointment before you go home.

What should I do if I am unwell at home?

If you notice any excessive swelling in your ‘breast’ or back, or develop excessive pain or fever, contact one of the following.

• Breast Care Nurses
  Telephone: 01227 868666 (Monday to Friday; 9am to 5pm)

• Emergency Department, Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate
  Telephone: 01843 235030
  The surgical registrar on-call will see you.

Further information

• Breast Cancer Now. Breast reconstruction.

• East Kent Hospitals. Deep vein thrombosis (DVT) patient leaflet.

• East Kent Hospitals. Pulmonary embolus (PE) patient leaflet.

• NHS. 5 A Day: what counts?

[Web sites last accessed 6 May 2026]

Ask 3 Questions

There may be choices to make about your healthcare. Before making any decisions, make sure you get the answers to these three questions:

• What are my choices?

• What is good and bad about each choice?

• How do I get support to help me make a decision that is right for me?

Your healthcare team needs you to tell them what is important to you. It’s all about shared decision making.

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