Comparing Latissimus Dorsi Flap to Implant in Breast Reconstruction Following Mastectomy in Breast Cancer Patients: A Systematic Review.

backgroundBreast cancer is the most common cancer in women worldwide and often necessitates a mastectomy. Many patients choose breast reconstruction (BR) to restore appearance and self-image. Common techniques include implant-based and autologous reconstruction, such as with the latissimus dorsi flap (LDF). This systematic review compares LDF and implant-based reconstructions to guide clinical decision-making and improve patient care.

methodsThis systematic review was conducted in accordance with PRISMA guidelines using PubMed, Cochrane, Web of Science, and VHL databases. Studies were included if they involved breast cancer patients who underwent mastectomy followed by either LDF or implant-based reconstruction. Study quality was assessed using STROBE guidelines.

resultsOut of 785 articles initially identified, 19 articles met the inclusion criteria. LDF and implant-based reconstructions had distinct indications, complication profiles, and long-term outcomes, with LDF reconstruction linked to lower revision rates, more natural aesthetic outcomes, and higher patient satisfaction despite donor site morbidity and more postoperative complications. Implant-based reconstruction had higher rates of revision and lower patient satisfaction, but is less invasive and associated with fewer postoperative complications.

conclusionLDF reconstruction is associated with lower revision rates, more natural aesthetic outcomes, and greater patient satisfaction despite higher donor site morbidity and increased postoperative complications. In contrast, implant-based reconstruction offers a less invasive option with fewer complications but is linked to higher revision rates and lower satisfaction. Optimal reconstruction outcomes require an individualized approach that carefully considers patient preferences, oncological factors, and procedural risks to support informed decision-making and enhance quality of life. This paper addresses a common clinical decision point in breast cancer care by directly comparing two widely used breast reconstruction techniques: LDF and implant-based reconstruction. Evidence-based insight into long-term outcomes, revision rates, and patient satisfaction is provided, which can help clinicians better counsel patients on their reconstruction options. This systematic review fills a gap in the literature by synthesizing data across multiple studies to guide future research and improve individualized breast reconstruction planning.  LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .