The Versatility of the Fat-extended, Muscle-sparing Latissimus Dorsi Flap in Breast Reconstruction

Background: The latissimus dorsi (LD) myocutaneous flap is widely used in breast reconstruction, often combined with implants, due to its reliable vascular axis. However, traditional techniques can result in functional deficits and complications. The fat-extended muscle-sparing LD flap (FEMSLDF) was developed to optimize breast volume restoration while minimizing complications. This study aimed to evaluate the effectiveness, safety, and patient satisfaction associated with the FEMSLDF. Methods: A prospective study was conducted on 172 patients who underwent FEMSLDF-based breast reconstruction (immediate, delayed, or salvage) between January 2018 and November 2023. The surgical technique prioritized preserving the LD muscle while using surrounding subcutaneous fat for volume restoration. Data on postoperative complications and patient-reported outcomes were collected, including BREAST-Q modules and the Patient and Observer Scar Assessment Scale. Results: The mean age of patients was 47±5.42 years, with a mean follow-up of 18.2±3.2 months. The mean surgical time was 65±23.1 minutes, with an average hospital stay of 2-3 days. Only 1 minor complication (0.58% incidence) was reported. BREAST-Q scores showed significant improvements in psychosocial, sexual, and physical well-being (P<0.05), whereas the LD module indicated preserved muscle functionality (P=0.2). Patient and Observer Scar Assessment Scale scores reflected high patient satisfaction with the dorsal scar. Conclusions: The FEMSLDF is a versatile, safe, and effective technique for breast reconstruction, achieving good aesthetic and functional outcomes with minimal complications. It represents a valuable alternative to traditional and hybrid reconstruction methods.