title: Current indications for and comparative analysis of three different types of latissimus dorsi flaps.
abstract: BACKGROUND
  Free tissue transfer with lower abdominal flaps for autologous breast reconstruction is not suitable for all patients. The latissimus dorsi (LD) musculocutaneous flap is an alternative, effective method for both immediate and delayed breast reconstruction.
  
  
  OBJECTIVE
  The authors assess their experience with LD flaps for breast reconstruction, including indications for patient selection, donor site choice, aesthetic outcomes, complications, and patient satisfaction.
  
  
  METHODS
  Charts for all patients who underwent breast reconstruction with one of three types of LD myocutaneous flaps during a three-year period at a single institution were retrospectively reviewed. Patients (n = 82) were divided into three groups: (1) 35 patients received a standard LD myocutaneous flap with implant, (2) 18 patients underwent a muscle sparing LD flap procedure with implant, and (3) 29 patients had an autologous LD flap. A questionnaire was administered to assess flap and donor site complications, aesthetic outcomes, patient satisfaction, and shoulder function.
  
  
  RESULTS
  Flap complications occurred in 13 patients (15%). Donor site complications occurred in 24 patients (28%), mostly consisting of back seroma with the autologous LD flap. There was no significant difference in shoulder range of motion or muscle strength between the operated and unoperated sides. Patient satisfaction was high in all three study groups.
  
  
  CONCLUSIONS
  The LD is a safe, versatile, and reproducible technique for breast reconstruction. The procedure benefits from ease of flap harvesting and setting and may provide satisfactory results in diverse patients, including those for whom an abdominal flap is neither indicated nor feasible. .
authors.affiliation: Department of Plastic Reconstructive Surgery and Burn Unit Center, Ospedale Niguarda, Piazza Ospedale Maggiore 3, Milan, Italy. s_bonami@fastwebnet.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonomi
authors.forename: Fernanda
authors.initials: F
authors.lastname: Settembrini
authors.forename: André
authors.initials: A
authors.lastname: Salval
authors.forename: Chiara
authors.initials: C
authors.lastname: Gregorelli
authors.forename: Gaetano
authors.initials: G
authors.lastname: Musumarra
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rapisarda
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D053580:Muscle Strength; D017060:Patient Satisfaction; D018579:Patient Selection; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000378:metabolism; D013524:Surgical Flaps; D016896:Treatment Outcome