Comparative Study of Myocutaneous Latissimus Dorsi Flap Breast Reconstruction With Implant Versus Lipofilling: Complication Rates and Risk Factors

BACKGROUND: Breast cancer is the most prevalent malignancy among women globally, and mastectomy often forms a critical part of its treatment. Breast reconstruction is an important aspect of post-mastectomy care, contributing to improved psychological well-being and quality of life. This study compares the outcomes of two distinct Latissimus Dorsi (LD) flap reconstruction techniques: one utilizing implant augmentation (LD-I) and the other employing autologous fat graft (lipofilling) for volume restoration (LD-L). METHODS: A retrospective cohort study was conducted, analyzing 116 patients who underwent breast reconstruction with either the LD-I or LD-L technique between 2013 and May 2024. Data was collected from two centers in Brazil. The primary outcome was the rate of major complications, defined as those requiring surgical re-intervention or hospital readmission. Secondary outcomes included the incidence of early (≤ 6 months) and late (> 6 months) complications and the correlation of clinical characteristics in regards to the complications, such as comorbidities and vices. RESULTS: The study population comprised 50 patients in the LD-I group and 66 patients in the LD-L group. The mean age of patients was approximately 50 years in both groups. There were no significant differences between the groups regarding oncologic characteristics, including tumor stage, histological subtype, and receipt of neoadjuvant or adjuvant therapies. While the overall rate of major complications was not statistically different between the two groups (18% LD-I vs. 7.6% LD-L, p = 0.079), specific complications varied. The LD-I group exhibited a significantly higher rate of early infections (20% vs. 6.1%, p = 0.023) and a greater incidence of late reconstruction loss due to implant-related issues (10% vs. 0%, p = 0.013). CONCLUSION: Both LD-I and LD-L techniques provide viable options for breast reconstruction. However, the LD-L technique demonstrated a lower risk of infection and reconstruction loss in this cohort. These findings suggest that LD-L may offer a favorable alternative for minimizing specific complications and improving long-term outcomes in post-mastectomy breast reconstruction. However, these findings should be analyzed with caution and further prospective, randomized studies with larger sample sizes are warranted to confirm these observations and to identify specific patient subgroups that may benefit most from each technique.