Latissimus Dorsi Flap This procedure is similar to a TRAM flap but the tissue used to reconstruct the breast comes from the latissimus dorsi muscle in the back. Because there is less body fat on this part of the back compared to the abdomen, this procedure is more appropriate for women with smaller breasts. In fact, latissimus dorsi flap surgery usually includes inserting an implant under the flap (the tissue moved from the back). The tissue moved from the back can remain attached to its original site, with the blood vessels uncut, so the tissue retains its own blood supply. Or, the tissue can be completely removed and transplanted to the chest. The blood vessels are cut and then reattached to blood vessels in the chest area using microsurgery techniques. A second, minor surgery is needed to reconstruct the nipple and areola. Latissimus dorsi flap surgery is somewhat easier than the TRAM flap and creates a smaller scar on the breast. On the other hand, it does create a scar on the back and leaves the back somewhat asymmetrical or uneven in appearance. Also, back skin usually has a different color and texture than breast skin. After the recovery period, you should regain full strength and function in your back.