Narrative review of breast reconstruction with a latissimus dorsi flap—is there a price to pay?

: The musculocutaneous latissimus dorsi flap is a stable workhorse in reconstructive plastic surgery. It is commonly used as a safe and viable alternative to the DIEP flap and possesses the advantage that it does not require microsurgical expertise. It offers a natural and aesthetically satisfying result, the complications rates are generally low and the postoperative length of hospitalization is short. Although investigated numerous times through the past decades, the functional effect of raising a latissimus dorsi flap remain debatable. We performed a review of the literature and identified studies that have investigated the functional effects after breast reconstruction with a m. latissimus dorsi flap. A reduction in shoulder strength for motions to which the muscle contributes could be intuitively expected following its dissection and have been reported by some authors. However, range of shoulder motion is unaffected in most studies and the subjective effect of the procedure on shoulder function remains ambiguously reported. The following article presents an overview of functional outcomes such as range of motion, shoulder strength and patient reported ability to perform activities of daily living following breast reconstruction with a latissimus dorsi flap. We also discuss other important factors regarding the outcome after m. latissimus dorsi flap, that should ideally be considered, when choosing and informing the patients about strategy for breast reconstruction.