Latissimus Dorsi Flap in Breast Reconstruction: Recent Innovations in the Workhorse Flap.

BACKGROUND: Surgeons employ the latissimus dorsi flap (LDF) for reconstruction of a large variety of breast cancer surgery defects, including quadrantectomy, lumpectomy, modified radical mastectomy, and others. The LDF may be used in delayed or immediate reconstruction, in combination with tissue expanders for a staged reconstruction, with implant-based immediate reconstruction, or alone as an autogenous flap.

METHODS: The authors discuss the historical uses and more recent developments in the LDF. More recent advancements, including the "scarless" approach and augmentation with the thoracodorsal artery perforator flap, are discussed.

RESULTS: The LDF is a reliable means for soft tissue coverage providing form and function during breast reconstruction with acceptable perioperative and long-term morbidities.

CONCLUSIONS: When there is a paucity of tissue, the LDF can provide tissue volume in autologous reconstruction, as well as a reliable vascular pedicle for implant-based reconstruction as in the setting of irradiated tissue.