The latissimus dorsi is a large muscle from the back that can be transferred to the breast for reconstruction. The blood supply to this muscle travels through the armpit or axilla. The muscle can be transferred with a small area of overlying skin and fat to reconstruct the mastectomy site. It is tunneled through the axilla and brought forward to the breast with the blood vessels intact. Usually an implant is necessary to create an adequately sized breast.
Tissue expansion is usually not necessary with this reconstruction. The breast can also be created in one stage at the same time as the mastectomy. The scar on the back usually heals well and can even be hidden in the line of the bra strap.
Loss of the latissimus muscle, however, does cause some weakness in the shoulder. In normal daily activity it may not be noticeable. Use of an implant can also cause capsular contracture. This is scar tissue formation around an implant that tightens over time causing a change in the appearance of the breast. Although this risk is less than in a tissue expander with implant reconstruction, it is still a significant problem.