A case of breast reconstruction using waistline incisional extended latissimus dorsi muscle flap

Breast reconstruction using extended latissimus dorsi (ELD) flap often results in a large and somewhat conspicuous back scar, even though several surgical design modifications have been reported. Patients often complain of self-consciousness when wearing bikinis and a reluctance to visit pools or hot springs where the back scar would be easily seen. We performed a single-stage breast reconstruction operation in which the ELD muscle flap with cutaneous fat pad was elevated through a waistline incision. The patient underwent a nipple-sparing mastectomy by breast surgeons. The patient's breast volume was small, and the weight of excised breast tissue was 74 g. As a result of this small size, the latissimus dorsi muscle flap with subcutaneous fat pad alone had sufficient volume for the patient's breast reconstruction, and the flap was elevated through the patient's waistline incision. The patient's undergarments easily hid the waistline scar, and her back was scar-free. Patients with smaller sized breasts who undergo a nipple-sparing mastectomy procedure and choose not to use synthetic implants can achieve successful reconstruction results using the waistline incisional ELD muscle flap.