Latissimus dorsi breast reconstruction--refinement and results

The surgical objectives for an improved breast reconstruction are defined. In 30 latissimus dorsi flap breast reconstructions only 1 major flap complication occurred. There were 7 lesser complications involving the donor wound on the back (n = 4), the flap (n = 2) and the mastectomy skin (n = 1). Several refinements in the technique provide for a more accurate replacement of the missing breast yet minimize complications on the back. A one-stage reconstruction (with immediate insertion of the prosthesis) is shown to be safe, except in the presence of recognizable damage to the thoracodorsal vascular pedicle. It is concluded that refinements in the use of the flap allow for a better breast reconstruction and that major complications are avoidable.