BACKGROUND: The latissimus dorsi (LD) myocutaneous flap, though once the mainstay of breast reconstruction, is now less frequently utilized due to the advent of other autologous breast reconstruction techniques. GOALS: To demonstrate the versatility and reliability of the LD myocutaneous flap for immediate breast reconstruction in patients who have contraindications to transverse rectus abdominis myocutaneous (TRAM) flap reconstruction or choose LD flap for its low morbidity and rapid recovery time. METHODS: Retrospective systematic chart reviews were performed. Patients that had undergone immediate breast reconstruction with LD myocutaneous flap by the senior author between October of 1995 and July of 2001 were included in the study. Total of 57 patients underwent 60 LD flap reconstructions during the study period. The indications for LD versus other autologous reconstruction, length of hospital stay, and complications were analyzed. RESULTS: The minimum length of follow up was 15 months (1.25 to 7 years). The overall flap site morbidity was 17.54%; the donor site morbidity was 19.3%. Average hospital stay was 2.72 days (1-7 days). Patients were pleased with aesthetic results of their reconstruction. CONCLUSIONS: The LD flap remains a viable and cost-effective option for immediate breast reconstruction with low morbidity and swift recovery.