Ask the Doctor – Can My Latissimus Flap Reconstruction Surgery Be Reversed?

This week, Dr. Kline, of The Center for Natural Breast Reconstruction, answers your question about breast reconstruction.

Question: I had that flap reconstruction 4 years after my mastectomy. That was 8 years ago. I’m in constant pain from the pulling in my chest. I hate that I can no longer paddle my canoe or swim.

I’m also having continued back problems that require the use of a chiropractor.

Can this procedure be reversed? I did not have any radiation or chemotherapy.

Answer: What type of flap did you have? It would be very unusual for a free tissue transfer (such as DIEP) to cause pulling, but not so unusual for pedicled flaps like a latissimus (or even a TRAM).

If you did have a latissimus, it could quite possibly be revised to improve your symptoms.

If you had a DIEP, it would require a little more investigation. Please let me know, and I’ll try to give you a more precise answer. I’d also be happy to chat with you by phone, if you wish.

Inquirer’s Response:

I believe it was a latissimus.

They used a portion of muscle from the side of my back, just a few inches lower than the armpit. The breast has also shifted slightly so that it isn’t centered in the chest anymore and is closer to the armpit.

In addition to the pulling pain in the chest, I’m having severe pain in the upper back, shoulders, and neck. I’ve also had recurring numbness and tingling in the hand and sharp pain shooting down my arm.

The chiropractor says that the realignment of the muscle will mean a forever battle of trying to keep the spine aligned and not pinching the nerve.  

Having the latissimus procedure is a huge regret for me. I wish I’d just had an implant.

The other breast just had a lumpectomy, rather than a full mastectomy. I have a small implant on that side that has never caused me any issues.

I want to know if the latissimus can be reversed and have an implant put in.

Answer from Dr. Kline:

I’m sorry you’re having so much trouble. That actually isn’t the norm for latissimus flaps, but it certainly can happen, as you know.

The latissimus can be transferred with or without dividing its motor nerve (thoracodorsal), and with or without dividing its attachment to the humerus (arm bone).

If the breast is shifting away from the center, that’s an indication that it may still be attached to the arm bone. If you have spasms, or intermittent pulling pain, it could be because the nerve isn’t divided, and the muscle is still functioning.

This doesn’t bother most people, but it definitely bothers some.

Sharp pain shooting down your arm (especially the inside of the upper arm) could indicate compression of the intercostobrachial cutaneous nerve, which lies in that area.

Offhand, I can’t think of an obvious anatomical explanation for your hand numbness and tingling, however.

Three muscles, the pectoralis major, the teres major, and the latissimus dorsi all attach to your upper arm bone at about the same place, and all pull the arm towards your body, but they each pull from a slightly different angle.

The latissimus is now rearranged to pull from the same angle as the pectoralis major. Usually, this does not cause a problem, but that’s not to say it never does.

It’s not really practical to actually “reverse” a latissimus flap, in the sense of putting it exactly back where it was. The flap can certainly be removed, however, and it is not at all unreasonable to think that that might help your symptoms.

In addition to perforator flap breast reconstruction, we also do implant reconstruction, but we shifted to placing the implant exclusively in front of the muscle about three years ago.

This can result in some visible rippling, but it has multiple benefits, including lack of animation deformity when the muscle is contracted, less chance of the implant coming out of position, less damage to the pectoralis muscle, and less discomfort.

Successful placement in front of the muscle is made possible by completely or nearly completely wrapping the implant in acellular dermal matrix (preserved skin, such as “Alloderm”), which heals to the tissue around it, and provides support.

While it may often be a very prudent decision to travel to see surgeons with extensive experience for complex procedures such as perforator flaps (DIEP, sGAP, PAP, etc.), simply removing the latissimus and placing an implant (or a tissue expander initially, which can be safer) requires no unusual skill, so I would recommend that you first consult your previous plastic surgeon, or another in your geographic area.

I would still be happy to speak with you about your situation, however, if you wish.

Have a great weekend, and thanks for your inquiry.

Have a question about breast reconstruction or post-surgery you’d like answered from our surgical team? Just ask!




  1. Diane Paxman says:

    Dear Gail, I am in the same situation as you…. can’t tell you how much I regret having a latimus dorsi reconstruction five years ago and not an implant. I have such a tight back, it drives me mad! How did you get on. I hope you have found some relief. I am in the UK and just beginning to explore if I can have this procedure revised to gain some relief.

    • Hi! I am in disbelief, I was only airing my regret to my husband yesterday.. I had my latissimus flap op around 8 years ago now. It’s never felt good, constant itching, tight across my chest, back ache, they just don’t feel like they belong to me. I am just starting to research to see if I can get a reversal but I’m not sure what I can have instead? I hope you have both found some answers and peace of mind to go forward

      • Diane Paxman says:

        Hi Louise, how did you get on trying to find some relief? I have had steroid and Botox injections which eased things a bit, for a while. But it is unsustainable at £1,000 every three months. Still in permanent discomfort. I am going to try acupuncture and if that doesn’t work I am going to try to have my operation revised… I personally would rather have an implant if possible or even be ‘lopsided’ than live like this. I hope you have found some relief! Xxx

    • Hi! I am in exactly the same position, constant itching that I can’t scratch, tightness across the chest , I feel they don’t belong to me. I had both my breasts reconstructed around 9 years ago and I regret not realizing I could have had other procedures. I was quite slim at the time and was told it was my only option. Please could anyone offer any advice who I could see in the U.K.? I sincerely hope this journey has not come to a halt for you all.

    • Candice says:

      Hello any update? My name is Candice and I am researching this for my mother. She is miserable because of this surgery.

  2. Mary Hartner says:

    Gail, i know your post is a year old and am hoping you see my response. I too had the same surgery 14 years ago. It’s the only regret in my life. At the time I was 45 with zero body fat it was my only option. I have suffered beyond belief. I pray you find relief and know you are not the only one. Today Dr. Newman at Cleveland Clinic referred me to Dr. Barnavon at Hollywood Memorial Hospital in Florida. I was told he is a brilliant surgeon and expert on latimus dorsi reconstruction. I’m giving him a chance. Someone out has to be able to help us. I live 80-90% of my life in debilitating pain. Prayers to you.

    • Suzie Decker says:

      Hi…my name is Suzie and my “flap” is suffocating me for lack of a better word. Please let me know if dr. In Florida is helpful. I’m at end of my rope!! Prayers for relief to us all!!

    • kathleen butler says:

      I too have had this surgery 10 years ago and it has ruined my life I so regret having it done but thought it was the best option for me at the time from the advice I got from my surgeon !I have been back to her many times and she has said reversal is not an option I have been back to surgery twice to remove flesh from under my arm I can honestly say the worst decision I have made in my life and no matter how you try to explain to family friends etc.only somebody that has it done will understand.Regards Kathleen Butler.

    • Tracy powell says:

      I had a latimmus dorsi transfer after a complete failure of my reconstruction using stomach tissue. I had a prophylactic mastectomy on my left breast and a revision of my reconstruction on the right side. Everything went well for six months until the doctor started filling the expanders, left side fine, but the right side started turning purple. Doctor removed the expander and some dead tissue. 4 months later he put the expander back in and he waited to expand it. Same problem occured and that expander had to be removed. I developed a large abscess on the chest wall with neurotic tissue. Eventually the hole got larger down to the bone. Only way to fix it was with a lat transfer. I am very slim with not much fat to lose,. So after 7 surgeries in two years I am left with a very bony chest and a small amount of tissue on my chest. Left side fine, but now I have to use a prosthetic on the right side. It has been2 years since this was done and the pain is nonstop, I feel like I have a vise grip around my chest and back and a knife under my shoulder blade. Has anyone found a way to have this fixed to control the pain

    • Amanda Brown says:

      Me too. I live in constant pain. I don’t know how much more I can take. I had my surgery 11 years ago. I never sleep because I can’t lay down without excruciating pain. I wish someone could help. It was a huge mistake. I have had nothing but trouble.

  3. Has anyone had a successful reversal?

  4. Same place. Regret this surgery. Miserable all the time. I feel like there is a piece of plastic in my chest.

  5. I also agree – I had my lat flap surgery in 1997, and here I am 22 years later, living with pain and pulling every day since. I feel I constantly have a tight belt around my ribs on my right side. I did this surgery so hopefully, I would appear okay, but today, this side is much smaller and saggy and shrunken – much smaller than my natural left side. I hate wearing a bra, and even after going thru this surgery, I still have to wear a prosthetic inside my bra anyway, so why did I do it at all?
    The thought of another surgery is just abhorrent to me. I do have back issues and scoliosis has formed. My Chiropractor tells me that I have to be very cognizant of doing posture and yoga and stretching to keep my back in alignment and that over time and with age, it may continue to get worse.

    It is the biggest regret of my life. I would rather just be missing one breast but have comfort.
    Oak Park, IL

  6. Eliza Hawkins says:

    I totally agree with all of you lovely ladies. I had the operation six years ago and have had various levels of pain, discomfort and nerve pain ever since. My arm feels as though it has a metal rod running through it, some days the pain is horrible and accompanied by a burning sensation in my hand other times pins and needles.
    If I don’t stretch my arm every day, my mobility reduces significantly. My posture is still wonky and I have large areas of complete numbness. I often become ‘trapped’ inside of my clothing. Without the flexibility it is impossible to undress and escape from the British polo neck jumper! I now buy bigger sizes for this reason.

    I am however truly thankful for every day of my life and for the medical care that I received.
    We never talk about the psychological effects of cancer. We make decisions during a time of great trauma and Often those decisions have to be made fairly quickly.Like the ladies above, I now know that some of my decisions Perhaps were the wrong ones. When you lose your breasts, your hair and your self identity, all you want is to feel normal again.

    Love and prayers to you x

  7. Diane Paxman says:

    Hi Louise, how did you get on trying to find some relief? I have had steroid and Botox injections which eased things a bit, for a while. But it is unsustainable at £1,000 every three months. Still in permanent discomfort. I am going to try acupuncture and if that doesn’t work I am going to try to have my operation revised… I personally would rather have an implant if possible or even be ‘lopsided’ than live like this. I hope you have found some relief! Xxx

  8. I had latissimus reconstruction 20 years ago and now I have had tons of problems with the pinched nerve in my mid back. I have fought it off and on for 5 years but I’m ready to fix it for good. It’s so painful and hard to put the spine back into alignment. The 2 chiropractors I went to ugly crying in pain had never heard of this. I wouldn’t do this surgery again if I could go back. I’m very active and have a very demanding job. How have others solved this problem?