Boomerang latissimus dorsi flap in total breast reconstruction: report of three cases

The latissimus dorsi (LD) flap is one of the most useful techniques for autologous breast reconstruction, especially in Asians. However, for reconstruction of moderate to large volume breasts, it is difficult to achieve the desirable volume and projection with the classic extended LD flap. Although there is the option of concurrent application of an LD flap and a small silicone implant, this may lead to larger volume than desired; furthermore, an increasing number of patients prefer reconstruction with autologous tissue alone. In this case report, we present satisfactory outcomes for moderate to large breast reconstruction in three patients, using the boomerang LD flap technique, a modification of the conventional extended LD flap. The flap was harvested with a transverse incision along the brassiere line and a vertical incision under the arm adjusted for the breast width of the patient. Then, after tunneling to the breast, the autologous reconstructed breast was created with the boomerang LD flap before moving the flap. There were no severe intraoperative or postoperative complications. In one case, linear necrosis of the breast wound was observed and the patient underwent revision operation for treatment. Seromas were not observed in the donor site of the boomerang LD flap and healing was successful. However, the donor site incision was 1.5 to 1.6 times longer than that of the classic LD flap. Boomerang LD flaps allow immediate breast reconstruction after neoadjuvant chemotherapy, without the need of microsurgery or use of abdominal-based flaps and without using silicone implants.