Latissimus flap breast reconstruction uses skin, fat and muscle (latissimus dorsi) from the back beneath the shoulder blade area. The tissue is brought around to the chest to create a new breast. If latissimus flap reconstruction is performed with a mastectomy ("immediate reconstruction"), the flap portion of the surgery won't begin until the mastectomy is completed. Following the mastectomy, the patient is turned onto the side or stomach and the flap harvest begins. A section of skin, fat and muscle is tunneled to the front of the chest to create the new breast. The patient is then turned onto her back to complete the shaping of the new breast.