A large muscle from the back called the latissimus dorsi muscle, or a muscle from the abdomen, the rectus abdominis muscle, are the most commonly used muscles for pedicled flap reconstruction.

This type of operation involves moving a flap of fat and overlying skin from the back of your body. The skin and underlying fat stays connected to the muscle in your back, and together with its own blood supply, the flap is tunnelled under the skin just below the armpit. The blood vessels of the flap stay attached to the body at the end nearest the armpit. The flap is positioned to create a new breast shape. If there is not enough tissue to create the whole breast form with the flap alone, an implant can be put behind it to give the desired size and shape. As the latissimus dorsi muscle is used, the operation is often referred to as the latissimus dorsi flap (LD flap).

This operation may leave some residual shoulder weakness as part of the muscle in the upper back is removed. Physiotherapy will help to build up the surrounding muscles, but the shoulder may always remain slightly weak. This is obviously an important consideration if you play any sport that involves the shoulder muscles.

This type of operation leaves scars where the skin and muscle flap is taken from the back, and also on the reconstructed breast. The scar around the reconstructed breast is oval-shaped. If a subcutaneous mastectomy has been done, the mastectomy scar may be under the breast fold. The nipple may or may not be preserved. If it is not preserved, the surgery may be planned so that the new reconstructed nipple, and tattooing afterwards, can mask the scar.

The scar on the back is usually horizontal, so a bra strap will generally cover it. Sometimes this scar is more diagonal. This can make it more difficult to cover with a bra, but can be covered by a swimsuit. You can discuss with your surgeon which type of scar you will have; a diagonal scar gives more skin for reconstruction.

This type of reconstruction generally has few problems and can recreate a small or moderate breast size very well.

In this operation a flap of fat and some muscle, with its overlying skin, is taken from the abdomen. It is then rotated (with its blood supply from the abdominal muscle), tunnelled upwards from the abdomen and placed on the chest wall to create the shape of a breast. This technique usually gives enough tissue to create a good-sized breast, so an implant is rarely needed. It is, however, major surgery involving a long operation with a hospital stay of around one week, and with perhaps more pain and discomfort initially.

This type of operation is sometimes referred to as a TRAM flap because the Transverse Rectus Abdominis Muscle is used.

The scar on the abdomen is usually horizontal and just below the bikini line. During the operation the tummy button (umbilicus) is repositioned. The scar around the breast will be oval.

Breast reconstruction using muscle, fat and skin flap rotation, from the back or abdomen, is major surgery and needs a hospital stay of at least one week.

Using a flap from the back generally gives less risk of complications than using a flap from the abdomen, but an implant is often needed.

Pedicled TRAM flap surgery is complex and complications can occur. It can only be used for women who are slim and who do not smoke. TRAM flaps can have blood supply problems, leading to the tissue at the edge of the flap, or sometimes all of the flap tissue, dying. Also, after the muscle of the abdominal wall has been removed as part of the operation, it is necessary to use a mesh to strengthen the muscles to prevent hernias or bulges.