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Updated: Jan 29, 2026

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Breast Reconstruction Using the Axillary-Approach Endoscopic Extended Latissimus Dorsi (Ax-eeLD) Flap.

Shinsuke Akita1, Yoshihisa Yamaji1, Haruka Maei1

  • 1Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.

Journal of Clinical Medicine
|January 28, 2026
PubMed
Summary

The axillary-approach endoscopic extended latissimus dorsi (Ax-eeLD) flap offers a minimally invasive breast reconstruction method, significantly reducing incision length without compromising safety or patient outcomes compared to conventional techniques.

Keywords:
BREAST-Qbreast cancerbreast hypoplasiabreast reconstructionendoscopic latissimus dorsi flap

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Area of Science:

  • Plastic Surgery
  • Surgical Innovation
  • Breast Reconstruction

Background:

  • Conventional endoscopic extended latissimus dorsi (eeLD) flaps minimize dorsal scarring but still require a lateral thoracic incision.
  • A novel axillary-approach endoscopic extended latissimus dorsi (Ax-eeLD) flap has been developed for harvest via a single axillary incision and small ports.

Purpose of the Study:

  • To evaluate the safety and feasibility of the Ax-eeLD flap.
  • To compare outcomes of the Ax-eeLD flap with the conventional eeLD flap.

Main Methods:

  • Retrospective analysis of patients undergoing Ax-eeLD flap harvest.
  • Comparison with a control group undergoing conventional eeLD flap.
  • Outcomes assessed included incision length, operative time, complications, need for fat grafting, and BREAST-Q scores.

Main Results:

  • The Ax-eeLD group had significantly shorter incisions (39 ± 1 mm) compared to the conventional eeLD group (89 ± 9 mm).
  • Operative times were comparable between groups.
  • Postoperative BREAST-Q scores improved similarly in both groups, with no significant difference in fat grafting requirements.

Conclusions:

  • The Ax-eeLD flap provides a technically feasible and safe method for minimally invasive latissimus dorsi muscle harvest.
  • This approach eliminates lateral thoracic scarring, offering an advantage in breast reconstruction.
  • Further prospective studies are warranted to objectively assess volume outcomes.