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Breast Reconstruction with Flap Procedures

A flap procedure uses your own tissue to form the shape of a breast. Two common types of flap procedures are the TRAM flap and the LD flap.

These surgeries are named based on what part of the body the tissue that is to be moved to the chest is taken from. Less often, tissue may be moved to the chest from the buttocks or thigh. Flap reconstruction surgeries leave you with two surgical wounds: the chest and the site where tissue was removed. 

Your surgeon can help you decide whether to have reconstructive surgery and what type is best for you. You will be advised to wait if now is not the best time for you, for instance, if you need radiation to your chest after surgery.

Front view of female breasts and abdomen showing TRAM flap breast reconstruction.

Front view of female breasts and abdomen showing LD flap breast reconstruction.


TRAM flap

The TRAM (transverse rectus abdominis myocutaneous) flap uses stomach muscle, fat, and skin. The new breast feels soft to the touch. A flap of skin and fat is removed from the lower part of the stomach. Then the flap may be tunneled under the skin from the stomach to the mastectomy site, or it may be cut free and moved there. The flap is then formed into the shape of a breast.

LD flap

The LD (latissimus dorsi) flap uses back muscle, fat, and skin. The new breast feels soft to the touch. The flap of skin and fat is removed from the side of the body, over the ribs. The latissimus dorsi muscle is left attached to the flap. Then the flap is tunneled under the skin to the mastectomy site. There it is formed into the shape of a breast. In some cases, an implant is needed with this surgery. 

Risks of flap reconstruction

Any type of surgery carries some risk. Patients differ in their anatomy and their ability to heal. Some problems related to breast reconstruction with a flap include: 

  • Bleeding

  • Fluid collection in either of the surgical areas

  • Anesthesia problems (problems with the medicines used to do the surgery)

  • Bruising and swelling

  • Implant problems 

  • Infection

  • Muscle weakness

  • Scar tissue

  • Increased complications in smokers

Note to smokers

Do not smoke at least 3 to 4 weeks before and 1 to 2 weeks after your procedure. Smoking can interfere with the healing process. Ask your healthcare provider for help quitting. 


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