The Combined Bra-Line Back Lift Latissimus Flap (BLBL-LAT Flap) for Aesthetic Breast Reconstruction and Simultaneous Back Contouring

Abstract

Background The latissimus dorsi pedicled (‘LAT’) flap has been a workhorse flap for breast reconstruction for many decades. The asymmetric back scar has been a major source of complaint. In patients with excess back adiposity, we can utilize the skin paddle harvest to improve back contour. We combined the principles of the esthetic bra-line back-lift with the LAT flap to provide simultaneous improvement of both posterior upper trunk adiposity and skin excess, which together form ‘back rolls’, using a concealed scar. Objectives To establish a new surgical technique of combined bra-line back lift with latissimus dorsi flap (‘BLBL-LAT flap’) for esthetic breast reconstruction. Methods This was an IRB-approved retrospective single-surgeon study performed in a national cancer center. We included patients undergoing breast reconstruction using combined BLBL-LAT flap between 2015 and 2023, with a minimum of 6 months follow up. Results 106 female patients underwent 110 breast reconstructions using BLBL-LAT flap. 75% of patients had prosthesis placement and 25% of patients were 100% autologous. Complication rates were low: 4/106 patients (3.8%) had seroma, needing surgery. Of the 78 reconstructions with implants, 3 (3.8%) had periprosthetic implant infection. One (<1%) patient had partial flap loss and no patients had complete flap loss. Four patients had bilateral BLBL-LAT flap reconstruction. Two unilateral breast reconstruction patients came back for successful symmetrizing bra-line back-lift (without LAT flap breast reconstruction). Conclusions The BLBL-LAT flap allows breast reconstruction and simultaneous improvement in back contour, using a scar that can be concealed in a bra. This two-for-one procedure is of particular benefit for patients with high BMI who often have unwanted excess adiposity and laxity of the back. Since this patient population are high risk for free tissue transfer, we propose that the BLBL-LAT flap should be considered the first-line method of autologous breast reconstruction in higher BMI patients.