Latissimus Dorsi Musculocutaneous Flap for Complex Breast Reconstruction: Indications, Outcomes and a Proposed Algorithm

Purpose: The latissimus dorsi (LD) flap is an ideal flap for salvage following failed primary breast reconstruction in the setting of radiation therapy. This study will review outcomes following secondary reconstruction with the LD flap with or without a tissue expander (TE) or implant (I). Methods: The following 4 cohorts were included: 1-stage LD only in 28 patients (48.3%), 1-stage LD + I in 7 patients (12.1%), 2-stage LD + TE/I in 8 patients (13.8%), and 3-stage LD + TE + I in 15 patients (25.9%). Results: The average age across all patients was 53.2 years. Complications did not differ significantly across the 4 cohorts. Complications included partial flap necrosis, wound dehiscence, seroma, and infection occurring in 4 of 28 patients of 1-stage LD alone, 2 of 7 (28.6%) patients of 1-stage LD + I, 5 of 8 (52.5%) patients of 2-stage LD + TE/I, and 4 of 15 (26.7%) patients of 3-stage LD + TE + I (P = 0.055). Reoperation rates were 10.7%, 14.3%, 25%, and 0% across the 4 cohorts, respectively (P = 0.295). The LD only cohort had a 14.3% surgical revision rate, compared with 42.9% in the 1-stage + I, 50% in the 2-stage + TE/I, and 33.3% in the 3-stage LD + TE + I (P = 0.135). The rate of contralateral symmetry procedures was 10.7%, 0%, 25%, and 6.7%, across the 4 cohorts, respectively (P = 0.410). Conclusion: Secondary breast reconstruction with the LD flap in 1, 2, or 3 stages has demonstrated success. A decision-making algorithm is provided.