Minimally invasive harvest of the latissimus dorsi flap for breast reconstruction: A systematic review

Background Poor cosmetic results with oncoplastic and implant-based breast reconstruction have stimulated an interest in latissimus dorsi flap (LDF)-based reconstruction. We reviewed the surgical techniques and outcomes of the LDF harvested with minimally invasive surgery. Methods A systematic search was conducted across PubMed-MEDLINE, Web of Science, Scopus, and Ovid-MEDLINE(R). Data on surgical outcomes were extracted. Results 31 articles were included reporting on 857 reconstructive procedures using a LDF harvested, 497 were endoscopic-assisted LDF (EALDF) (58%) and 174 were robotic-assisted LDF (RALDF) (20.3%). The average flap harvest time was 84.04-min for EALDF and 106.14-min for RALDF. With an EALDF, the incidence of haematoma, seroma, and wound dehiscence ranged between 0%-16.6%, 0%-48%, and 0%-6.2%, respectively. Using RALDF, the incidence of seroma was between 0%-26.1% and 0%-3.4% for haematoma. Conclusions While the indications for a LDF harvested with MIS are limited, its main advantage for breast reconstruction is the absence of the back scar.