Endoscopic Assisted Latissimus Dorsi Musculocutaneous Flap for Breast Reconstruction

The latissimus dorsi (LD) musculocutaneous flap is a well-established option for breast reconstruction because of its reliable vascular anatomy and versatility. However, conventional flap harvest requires a long dorsal incision that may result in visible scarring, postoperative pain, seroma formation, and donor-site morbidity. Endoscopic-assisted harvest has been developed to minimize donor-site scarring while preserving the advantages of the conventional technique. Although endoscopic harvest of the muscle-only flap has been increasingly reported, evidence regarding endoscopic-assisted harvest of the musculocutaneous latissimus dorsi flap remains limited because inclusion of a skin paddle presents additional technical challenges.

This prospective case series was conducted at Kasr Al Ainy Hospital, Cairo University, to evaluate the feasibility, safety, and clinical outcomes of endoscopic-assisted latissimus dorsi musculocutaneous flap harvest in women requiring breast reconstruction following breast cancer treatment or burn deformity. Eligible patients required autologous reconstruction using a musculocutaneous flap with a skin paddle measuring no more than 6 cm in its greatest dimension and had an intact latissimus dorsi muscle and thoracodorsal vascular pedicle.

All procedures were performed under general anesthesia using an endoscopic-assisted technique through a limited donor-site incision. The flap was harvested under endoscopic visualization while preserving the thoracodorsal vascular pedicle, followed by transfer of the flap to the breast defect. Standard postoperative management and follow-up were performed for one year.

Outcome measures include flap viability, operative time, postoperative pain, drain output and duration, donor-site and recipient-site complications, scar quality assessed using the Vancouver Scar Scale, and patient-reported satisfaction measured using the BREAST-Q questionnaire. The study aims to determine whether endoscopic-assisted harvest of the latissimus dorsi musculocutaneous flap provides reliable breast reconstruction with reduced donor-site morbidity and improved cosmetic outcomes compared with those historically reported for conventional open harvest.

Inclusion criteria

• Female patients aged 18 to 65 years.
• Patients with post-oncologic or post-burn breast deformities requiring autologous breast reconstruction.
• Patients requiring reconstruction with a latissimus dorsi musculocutaneous flap incorporating a skin paddle measuring ≤6 cm in its greatest dimension.
• Defects considered unsuitable for correction with local tissue rearrangement.
• Intact latissimus dorsi muscle and thoracodorsal vascular pedicle.
• Ability to provide written informed consent and comply with the study follow-up schedule.

Exclusion criteria

• Age younger than 18 years or older than 65 years.
• Body mass index (BMI) >35 kg/m².
• Uncontrolled medical comorbidities or immunosuppressive conditions.
• Absence of a skin defect requiring reconstruction.
• Cutaneous defects requiring a skin paddle >6 cm in its greatest dimension.
• Inadequate oncologic control or evidence of active disease.
• Ongoing adjuvant chemotherapy or radiotherapy at the time of reconstruction.
• Previous thoracic surgery or trauma compromising the latissimus dorsi muscle or thoracodorsal vascular pedicle.
• Inability or unwillingness to comply with study follow-up.