Endoscopic-assisted Versus Open Latissimus Dorsi Flap Harvest for Breast Reconstruction: A Randomized Comparative...

The latissimus dorsi (LD) flap remains a reliable option for breast reconstruction; however, the long donor-site scar represents a major concern. Endoscopic-assisted LD flap harvest has been introduced to improve cosmetic outcomes while maintaining reconstructive efficacy. The current study evaluates endoscopic-assisted LD flap harvest for breast reconstruction and compares it with the open technique regarding donor-site morbidity, cosmetic outcome, patient satisfaction, and operative variables.

A prospective randomized controlled trial was conducted at Kasr Al Ainy Hospital between January 2023 and July 2025. Fifty-nine female patients (60 flaps) seeking breast reconstruction (without skin deficiency or requiring a skin island ≤6 cm in the longest dimension) were included. Patients were randomly assigned to undergo an endoscopic-assisted (group A) or open (group B) LD flap harvest. Ethical approval was obtained from Cairo University (approval no.: MD-242-2023).

Group A demonstrated significantly higher donor-site satisfaction with shorter scars (5.87 versus 19.45 cm, P < 0.001), but required longer operative time (3.42 versus 1.72 h, P < 0.001). Breast satisfaction scores and complication rates were comparable between groups. Hospital stay and recovery were slightly shorter in group A.

Endoscopic-assisted LD flap harvest is a safe and effective technique offering superior aesthetic results with reduced scarring. Although associated with an advanced learning curve and longer operative time, careful patient selection and personalized treatment planning can optimize results.