Fat-augmented latissimus dorsi flap and implant-based latissimus dorsi flap: A systematic review

Implant-related concerns have increased the interest in the use of complete autologous latissimus dorsi (LD) flaps in breast reconstruction. To achieve the desired volume without implants, autologous fat transfer can be used to enhance the breast size. Fat-augmented LD (FALD) flap is an alternative technique for volume enhancement that incorporates autologous fat grafting, thereby replacing the need for implants.

A systematic literature search was performed according to the preferred reporting items for systematic reviews and meta-analyses protocol using the PubMed, Embase, Web of Science, Scopus, CENTRAL, ICTRP and Clinicaltrials.gov databases. Data on patient-reported outcomes and clinical outcomes were extracted.

The electronic database search identified 2606 records, among which 71 met the inclusion criteria. A total of 67 articles were included in the statistical analysis, reporting on 1185 FALD and 3958 implant-based LD flap breast reconstructions. Patient demographics and treatment characteristics were generally comparable across studies. The reported minor complication rate for implant-based LD was 23.9% (95% confidence intervals [CI]: 18.2-30.6%) and 25.1% (95% CI: 17.5-34.5%) for FALD. The major complication rate was 2.4% (95% CI: 1.3-4.4%) in the FALD group and 4.9% (95% CI: 3.4-7.2%) in the implant-based LD group.

This systematic review provides an overview of the current literature on both techniques and presents the available data on complication rates and patient-reported outcomes. The findings suggest that FALD is a safe alternative, with a potential trend towards lower major complication rates. Further high-quality comparative studies are needed to enable direct comparison and to draw more definitive conclusions.