Latissimus Dorsi Flap in Breast Reconstruction: When the Classic Still Works

The latissimus dorsi flap may look like a classic car next to modern microsurgical reconstruction, but there are clinical situations where this reliable workhorse still becomes invaluable.

Andrii Zhygulin walks through the evolution of the technique, its current indications in total and partial breast reconstruction, and—perhaps most importantly—its role in salvage surgery when previous reconstruction has failed. The lecture combines operative principles with the speaker’s own series of 24 post-mastectomy and 18 partial reconstructions, including long-term clinical cases.

The practical focus goes far beyond flap harvest: donor-site and skin-island design, preserving superficial fascia, gaining adequate volume, combining the flap with implants, shaping the reconstructed breast in a physiologic position, and managing the trade-off between mobility and tissue trauma. Particular attention is given to seroma prevention, animation deformity, ischemic problems, radiation-related changes, scar placement and rehabilitation.

The discussion after the lecture expands into implant selection, prepectoral versus retropectoral reconstruction, timing of radiotherapy, flap monitoring and the question every reconstructive surgeon eventually faces: when is an LD flap still the right operation—and when is there a better option?