ABSTRACT
This chapter explores the history, practicality, complications, outcomes and future of the latissimus dorsi (LD) flap. More recently, with the realisation that immediate reconstruction was both possible and preferred, the LD flap technique evolved into the re-creation of the breast mound sitting wholly superficial to the pectoralis major. The LD flap operation consists of three phases. None of these should take more than one hour. The patient lies in the supine position with the arm draped to allow planned simultaneous sentinel node biopsy and/or axillary dissection. Up to 25% of LD flap patients benefit from adjustment surgery. Implant-alone rebuild is a quicker procedure for the surgeon and the patient with fewer complications and a quicker return to ‘normality', better muscular function and lack of seroma. The use of matrix, mesh and deep inferior epigastric perforators threatened the role of the LD. To counter this, the LD flap enthusiasts have hit back with innovations of their own, both front and back.
