Latissimus Dorsi Flap in Reconstructive Surgery

Purpose and Benefits

The latissimus dorsi flap serves as a myocutaneous tissue flap that can replace relatively large volumes of breast tissue in reconstruction following mastectomy, providing both coverage and volume with acceptable donor-site morbidity and improved quality of life for patients, as recommended by the National Comprehensive Cancer Network 1, 2, 3
Improves quality of life for patients who have undergone mastectomy by addressing cosmetic, body image, and psychosocial issues, according to the National Comprehensive Cancer Network 2, 3
Can be used alone or in combination with implants to achieve better symmetry and volume, as suggested by the National Comprehensive Cancer Network 2, 3

The LD flap utilizes the latissimus dorsi muscle from the back, which has a reliable blood supply from the thoracodorsal artery, as described in Annals of Oncology 1, 4, 5
The flap can be designed as a muscle-only flap or as a myocutaneous flap that includes both muscle and overlying skin, according to the Journal of the National Comprehensive Cancer Network 3
The flap is elevated with its vascular pedicle and tunneled to the anterior chest wall or breast area, as described in Annals of Oncology and the Journal of the National Comprehensive Cancer Network 1, 3, 4, 5

Patient selection and assessment of suitability for LD flap reconstruction should consider factors such as smoking status and obesity, which are relative contraindications due to increased risk of complications, as recommended by the National Comprehensive Cancer Network 2, 3
The procedure can be performed as immediate reconstruction at the time of mastectomy or as delayed reconstruction any time after mastectomy, according to the Journal of the National Comprehensive Cancer Network 2, 3
May be preferred over implant-based reconstruction in patients who will undergo radiation therapy, as autologous tissue better tolerates radiation, as described in Annals of Oncology and the Journal of the National Comprehensive Cancer Network 1, 3

Radiation therapy may affect the cosmetic outcome but autologous tissue generally tolerates radiation better than implants, as described in Annals of Oncology and the Journal of the National Comprehensive Cancer Network 1, 3
Smoking and obesity increase the risk of wound healing complications and partial or complete flap failure, according to the National Comprehensive Cancer Network 2, 3
The procedure may require additional surgeries on the contralateral breast to achieve optimal symmetry, as suggested by the National Comprehensive Cancer Network 2, 3