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The Low Transverse Extended Latissimus Dorsi Flap Based on Fat Compartments of the Back for Breast Reconstruction: Anatomical Study and Clinical Results

Bailey, Steven H. M.D.; Saint-Cyr, Michel M.D.; Oni, Georgette M.R.C.S.; Wong, Corrine M.R.C.S.; Maia, Munique M.D.; Nguyen, Viet B.Sc.; Pessa, Joel E. M.D.; Colohan, Shannon M.D.; Rohrich, Rod J. M.D.; Mojallal, Ali M.D.

Plastic and Reconstructive Surgery: November 2011 - Volume 128 - Issue 5 - p 382e–394e
doi: 10.1097/PRS.0b013e31822b7a3b
Breast: Original Article

Background: Despite many modifications to the extended latissimus dorsi flap, its use in autologous breast reconstruction remains limited because of insufficient volume and donor-site morbidity. Through a detailed analysis of the deposition of back fat, this study describes a low transverse extended latissimus dorsi flap harvest technique that increases flap volumes and improves donor-site aesthetics.

Methods: Eight fresh cadaver hemibacks were used to identify the anatomical location of the fat compartments. Correlation between the fat compartments and the fat folds was made using photographic analysis of 216 patients. Retrospective case note review was conducted of all patients who had a low transverse extended latissimus dorsi flap performed by the senior author (M.S.-C.).

Results: Cadaveric dissection and photographic analysis confirmed the presence of the four distinct fat compartments in the back. The lower compartments 3 and 4 were the most frequently identified and the largest, with mean values of 367 cm3 and 271 cm3, respectively. The clinical series comprised eight high–body mass index patients who underwent 12 pure autologous breast reconstructions using the low transverse skin paddle harvest technique. Donor-site complications included partial dehiscence (n = 2) and minor infection (n = 3). There were no instances of seroma, and fat necrosis (<5 percent) occurred in one breast.

Conclusions: The low transverse skin paddle extended latissimus dorsi flap is reliable and provides sufficient volume for purely autologous breast reconstruction with low donor-site morbidity and improved body contouring for a select group of patients. The authors' initial experience with high–body mass index patients shows promising results with this flap in a challenging group.


Dallas, Texas; and Lyon, France

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, and the Department of Plastic and Reconstructive Surgery, Edouard Herriot Hospital, University of Lyon.

Received for publication December 14, 2010; accepted April 14, 2011.

Disclosure:The authors have no financial interests in this research project or in any of the techniques or equipment used in this study.

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Michel Saint-Cyr, M.D.; Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390-9132,

©2011American Society of Plastic Surgeons