Latissimus Dorsi Flap for Breast Reconstruction: Indications, Technical Variants, Outcomes, And Contemporary Role

The latissimus dorsi flap remains one of the most reliable and versatile options in breast reconstruction. Although the increasing use of perforator-based microsurgical flaps and implant-based techniques has changed reconstructive algorithms, the latissimus dorsi flap continues to play an important role in immediate and delayed reconstruction, salvage procedures, partial breast reconstruction, irradiated fields, and patients who are not ideal candidates for abdominal free flaps. The flap may be transferred as a muscle-only, myocutaneous, fat-extended, muscle-sparing, or hybrid flap combined with an implant or tissue expander. Its advantages include consistent vascular anatomy, robust perfusion, predictable transfer, and applicability in complex clinical scenarios. The main limitation is donor-site morbidity, particularly seroma, although modern muscle-sparing, fat-augmented, anterior-approach, and optimized skin-paddle designs aim to reduce complications and improve aesthetic outcomes. Long-term studies generally report high patient satisfaction, acceptable complication rates, low total flap loss, and limited persistent shoulder dysfunction. This review summarizes the indications, operative variants, outcomes, complications, patient-reported satisfaction, and contemporary role of the latissimus dorsi flap in breast reconstruction.