Introduction: The extended latissimus dorsi flap is reliable for autologous breast reconstruction in select cases. It is useful in postmastectomy patients in whom abdominal flaps are contraindicated and in patients who prefer not to undergo implant-based reconstruction. Flap harvest is more involved than that of the standard latissimus flap as additional tissue must be recruited to provide the needed volume for reconstruction. This study was undertaken to assess a single surgeon's technique and outcomes with the extended latissimus dorsi musculocutaneous flap for postmastectomy breast reconstruction.
Methods: Medical records of all patients who underwent postmastectomy breast reconstruction in a 10-year period were retrospectively reviewed. Patients who underwent unilateral or bilateral, delayed or immediate extended latissimus breast reconstruction were included. Patients who underwent tissue expansion and implant placement in addition to a latissimus flap, standard latissimus reconstruction, or had insufficient follow-up were excluded. Epidemiologic data, tumor diagnosis, mastectomy type, length of hospital stay, flap complications, donor site complications, length of follow-up were recorded and analyzed. Data obtained from operative reports included surgical technique and skin island size. Flap design consisted of a near-transverse elliptical skin paddle, the latissimus muscle, and the fat pad deep to the superficial thoracic fascia and overlying the latissimus muscle.
Results: Twelve reconstructions were performed in 10 patients, with bilateral reconstructions in 2 patients. Eight were immediate while four delayed reconstructions were performed. Mean patient age was 60 years (range 47 – 77 years). Mean body mass index was 33.2 kg/m2 (range 25.2 – 40 kg/m2). Four patients received adjuvant radiation therapy before breast reconstruction. Mean skin paddle area was 22.3 x 8.6 cm (150cm2) Donor site drains were left in place for an average of 21 days (range 11-29 days). The mean follow-up was 20.6 months (range 1 – 93 months). Flap complications developed in 2 of 12 flaps (16.7 percent); both were partial flap losses requiring reoperation. Donor site complications developed in 8 of 12 donor sites (66.7 percent). The most common donor site complication was seroma formation. Partial mastectomy skin flap necrosis occurred in four patients.

Conclusion: The extended latissimus dorsi musculocutaneous flap can provide total autologous breast reconstruction in select cases, specifically in women who are poor candidates for implant-based reconstruction and in those with contraindications to an abdominal flap. Safe, large-volume breast reconstruction is possible by harvesting a flap that includes only fat directly overlying the latissimus muscle.