Breast reconstruction with a combination of implant and flap

Combination methods are appropriate in a number of circumstances. If implant reconstruction is preferred, but the tissues on the chest are insufficient to provide healthy cover, a tissue transfer can be employed to house and protect the device. Also, some patients may seek somewhat greater fullness than a particular flap can provide on its own, leading the surgeon to augment the tissue transfer with a small implant. Finally, combination methods are of great use in bilateral reconstructions when tissue alone cannot provide the breast size desired on two sides.

This type of breast reconstruction requires the use of a smaller tissue expander/implant along with your own tissue because of the limited volume of your back tissue.


This flap borrows muscle and skin from the upper back. Although this method provides much of the needed skin, there isn’t enough tissue volume to form the breast mound by itself, so either a tissue expander or implant can be used to stretch the transferred muscle and skin. At a later stage the tissue expander is replaced with a permanent implant.

This procedure is most commonly performed if you’ve had a mastectomy on one of your breasts followed by radiation and don’t meet the criteria for a TRAM or DIEP flap. This procedure is not recommended if you perform a lot of repetitive or strenuous overhead activities with your arms.


Using the latissimus dorsi (known as an LD flap) with an implant reduces the risk of complications such as infections, implant extrusion (when the body rejects the implant), or capsular contracture (excessive or invasive scar tissue formation).

It generally creates a more natural looking breast than using an implant alone.

Patients can avoid scars on the tummy, buttocks and thighs.

The LD flap combined with an implant is a popular choice for women with a larger breast size.


Because a muscle is removed from the back, some women may experience weakness in the shoulder. Although physiotherapy can help, the shoulder may never fully regain its former strength. This may be an important consideration for women who are very active, for example, those who swim, climb or play tennis or golf.

Implants don’t last a lifetime (and risk rupture) and therefore will need further replacement surgery at some point.