Latissimus dorsi flap for breast reconstruction
DOI:
https://doi.org/10.18203/2349-2902.isj20253737Keywords:
Latissimus dorsi flap, Breast reconstruction, Donor-site morbidity, Seroma, Shoulder function, Fat grafting, Muscle-sparing technique, Reconstructive surgeryAbstract
The latissimus dorsi flap (LDF) is a reliable and time-tested autologous option for breast reconstruction following mastectomy or breast-conserving surgery. It can be harvested as a myocutaneous or muscle-only flap, with or without fat grafting or implant placement, allowing tailored reconstruction based on patient anatomy, comorbidities, and aesthetic goals. The LDF is especially advantageous in patients who are not suitable candidates for abdominal-based free flaps or who present with compromised local tissues after radiation or failed reconstruction. Recent refinements, such as immediate fat augmentation and muscle-sparing techniques, have expanded its reconstructive versatility and improved donor-site outcomes. The most common complications are donor-site related, with seroma formation being the predominant issue, reported in up to 40% of cases. Other complications include hematoma, wound dehiscence, infection, and partial flap necrosis, though total flap loss is rare. Functional morbidity, particularly mild shoulder weakness or limited range of motion, may occur but generally has minimal impact on daily activities. Techniques preserving the thoracodorsal nerve and minimizing muscle harvest significantly reduce postoperative morbidity. Overall, the LDF provides consistent aesthetic and functional results, making it a valuable and versatile reconstructive option. Its safety, reliability, and adaptability-particularly when integrated with fat grafting-ensure its continued role in contemporary breast reconstruction.
Metrics
References
Abdou SA, Charipova K, Song DH. Modern approaches to pedicled latissimus dorsi flap breast reconstruction with immediate fat transfer. Clin Plast Surg. 2023;50(2):259-65. DOI: https://doi.org/10.1016/j.cps.2022.10.004
Liu Q, Li W, Wu X, Liang X, Pinghua H, Yali C. Immediate breast reconstruction using latissimus dorsi muscular flap: A retrospective study of Chinese patients with breast cancer. Medicine. 2021;100(24):e26175. DOI: https://doi.org/10.1097/MD.0000000000026175
Zheng S, Hao S, Chen J, Yingying Z, Benlong Y, Xiaoyan H, et al. Latissimus dorsi flap-the main force in breast reconstruction for breast tumor in Chinese population. Front Oncol. 2023;13:1159073. DOI: https://doi.org/10.3389/fonc.2023.1159073
Cogliandro A, De Bernardis R, Calabrese G, Rosa S, Valeria P, Barbara C, et al. Muscular versus myo-cutaneous latissimus dorsi flap in delayed breast reconstruction: A comparative study of postoperative outcomes. Aesthetic Plast Surg. 2025;NA. DOI: https://doi.org/10.1007/s00266-025-05042-0
Banys-Paluchowski M, Brus L, Krawczyk N, Sophie VK, Maria LG, Nana B, et al. Latissimus dorsi flap for breast reconstruction: A large single-institution evaluation of surgical outcome and complications. Arch Gynecol Obstet. 2024;309(1):269-80.
Zheng H, Zhu G, Guan Q, Wei F, Xiang L, Mancheng Y, et al. A retrospective study of latissimus dorsi flap in immediate breast reconstruction. Front Oncol. 2021;11:598604. DOI: https://doi.org/10.3389/fonc.2021.598604
Tomita K, Taminato M, Kubo T. Total breast reconstruction with a fat-augmented latissimus dorsi flap: A comparative study between muscle and myocutaneous flaps. J Plast Reconstruct Aesthet Surg. 2023;83:250-7. DOI: https://doi.org/10.1016/j.bjps.2023.04.081
Bucaria V, Giudice G, Boccuzzi A, Ilaria C, Michele M, Rossella E. “No-back-scar” latissimus dorsi muscle flap and tissue expander: A valuable strategy for secondary breast reconstructions. Aesthetic Plast Surg. 2024;48(11):2098-107. DOI: https://doi.org/10.1007/s00266-023-03595-6
Mericli AF, Szpalski C, Schaverien MV, Jesse CS, David MA, Patrick BG, et al. The latissimus dorsi myocutaneous flap is a safe and effective method of partial breast reconstruction in the setting of breast-conserving therapy. Plast Reconstruct Surg. 2019;143(5):927e-35. DOI: https://doi.org/10.1097/PRS.0000000000005577
Banys-Paluchowski M, Brus L, Krawczyk N, Sophie VK, Maria LG, Nana B, et al. Latissimus dorsi flap for breast reconstruction: A large single-institution evaluation of surgical outcome and complications. Arch Gynecol Obstet. 2024;309(1):269-80. DOI: https://doi.org/10.1007/s00404-023-07186-3
Arikawa M, Miyamoto S, Fujiki M, Takuya H, Azusa O, Minoru S. Comparison of donor site drainage duration and seroma rate between latissimus dorsi musculocutaneous flaps and thoracodorsal artery perforator flaps. Ann Plast Surg. 2017;79(2):183-5. DOI: https://doi.org/10.1097/SAP.0000000000001077
Wang Y, Liang C, Lin Q, Lin F, Libo L, Haoran J, et al. Donor-site morbidity and aesthetic outcomes in patients undergoing head and neck reconstruction with anterolateral thigh or latissimus dorsi flaps: A systematic review and meta-analysis. J Cranio-Maxillo-Facial Surg. 2025;53(10):1892-903. DOI: https://doi.org/10.1016/j.jcms.2025.08.012
Højvig JH, Henriksen M, Bartholdy CR, Bonde CT. Donor-site morbidity following breast reconstruction with a latissimus dorsi flap: A prospective study. J Plast Reconstruct Aesthet Surg. 2022;75(7):2205-10. DOI: https://doi.org/10.1016/j.bjps.2022.01.036
Lee KT, Mun GH. A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer. Plast Reconstruct Surg. 2014;134(2):303-14. DOI: https://doi.org/10.1097/PRS.0000000000000365
Oberhofer HM, Samant SS, Swan CC, Erin MW, Ellen SS, Mark ML, et al. Objective comparison of donor-site morbidity following full and thoracodorsal nerve-preserving split latissimus dorsi flaps. Plast Reconstruct Surg. 2022;149(5):966e-71e. DOI: https://doi.org/10.1097/PRS.0000000000009022
Gatto A, Parisi P, Brambilla L, Ilaria S, Annarita V, Federico LT, et al. Thoracodorsal artery perforator flap, muscle-sparing latissimus dorsi, and descending branch latissimus dorsi: A multicenter retrospective study on early complications and meta-analysis of the literature. J Plast Reconst Aesthet Surg. 2022;75(11):3979-96. DOI: https://doi.org/10.1016/j.bjps.2022.06.083
Yezhelyev M, Duggal CS, Carlson GW, Losken A. Complications of latissimus dorsi flap breast reconstruction in overweight and obese patients. Ann Plast Surg. 2013;70(5):557-62. DOI: https://doi.org/10.1097/SAP.0b013e31827a2c02
Steffenssen MCW, Kristiansen AH, Damsgaard TE. A systematic review and meta-analysis of functional shoulder impairment after latissimus dorsi breast reconstruction. Ann Plast Surg. 2019;82(1):116-27. DOI: https://doi.org/10.1097/SAP.0000000000001691
