The dorsal flap (latissimus dorsi) is technically simpler to carry out than the TRAM. The vascularization is safer than with an abdominal flap and can be offered to patients for who a TRAM is not suitable due to a vascular problem or smoking habits. It experienced a great development in recent years thanks to an increase in possible secondary volume using lipofilling, which permits to realize autologous dorsal flaps. It has the disadvantage of associating a dorsal scar and the volume obtained is more limited than with a TRAM. The follow-up after surgery is easier than the TRAM’s and a full recovery is expected within 6 weeks.
In my practice, I use it as an autologous graft for breasts of small or average volume
and more rarely for bigger volumes.
I add a prosthesis behind the flap if a substantial volume is necessary.
In that case, the progressive risk (capsula contracture and asymmetry over time) is the same as a reconstruction with prosthesis.