Beyond the Classic Latissimus Dorsi Flap: A Decision-Making Algorithm for Technique Selection in Complex Breast...

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncologic Surgery

Background:

• The latissimus dorsi (LD) flap is a key technique for breast reconstruction, particularly for patients who have had radiation therapy, require salvage procedures, or are not candidates for microsurgery.
• Existing literature lacks comprehensive guidance on selecting among various LD flap techniques.

Purpose of the Study:

• To analyze the application of different latissimus dorsi (LD) flap variants in breast reconstruction.
• To develop a decision-making algorithm for selecting the optimal LD flap technique based on patient and defect characteristics.

Main Methods:

• Retrospective analysis of 40 consecutive LD-based breast reconstructions across two Italian centers over five years.
• Classification of flaps into classic LD, hybrid LD, extended LD, V-FALD, and KISS flap categories.
• Evaluation of clinical variables, reconstructive setting, complications, and reoperations.

Main Results:

• The study population (40 patients) had high complexity, with 90% receiving radiotherapy and 55% undergoing salvage reconstruction.
• Hybrid LD flaps were most common (57.5%), followed by KISS (15%), extended LD (12.5%), V-FALD (10%), and classic LD (5%).
• Selection criteria included skin envelope adequacy, required breast volume, and autologous reconstruction feasibility. Major complications were low (5%), with no total flap loss.

Conclusions:

• LD-based breast reconstruction is a flexible platform, not a monolithic technique.
• A practical algorithm can guide surgical planning, enabling tailored selection of LD flap variants to match specific reconstructive needs and goals.
• This approach aims to optimize outcomes in complex breast reconstruction scenarios.