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 aesthetic 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,” with a concealed scar. Objectives The objective was to establish a new surgical technique of combined bra-line back lift with latissimus dorsi flap (BLBL-LAT flap) for aesthetic breast reconstruction. Methods This was an IRB-approved retrospective single-surgeon study performed in a national cancer center. We included patients undergoing breast reconstruction with the combined BLBL-LAT flap between 2015 and 2023, with a minimum of 6 months of follow-up. Results A total of 106 female patients underwent 110 breast reconstructions with the BLBL-LAT flap. Seventy-five percent of patients had prosthesis placement and 25% of patients were 100% autologous. Complication rates were low: 4 of 106 patients (3.8%) had seroma, needing surgery. Of the 78 reconstructions with implants or tissue expanders, 3 (3.8%) had a periprosthetic 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 of the bra-line back lift (without LAT flap breast reconstruction). Conclusions The BLBL-LAT flap allows breast reconstruction and simultaneous improvement of back contour, leaving a scar that can be concealed in a bra. This 2-for-1 procedure is of particular benefit to patients with a high BMI, who often have unwanted excess adiposity and laxity of the back. Because this patient population is at high risk for free tissue transfer, we propose that the BLBL-LAT flap be considered the first-line method of autologous breast reconstruction in higher BMI patients. Level of Evidence: 4 (Therapeutic)