Immediate lipofilling in fat-augmented latissimus dorsi flap for breast reconstruction: a versatile and fully autologous option. Case report and technical considerations.

Introduction: The latissimus dorsi (LD) flap is a well-established option for breast reconstruction because of its reliable vascular pedicle and technical versatility. However, its main limitation is the relatively limited volume it provides, which has traditionally required the addition of a prosthetic implant to achieve adequate breast projection and symmetry. In selected patients with small- to moderate-sized breasts, the fat-augmented latissimus dorsi (FALD) flap may overcome this limitation by combining the LD flap with fat grafting. Presentation of case: We present the case of a patient who underwent a skin-sparing mastectomy with nipple-areolar complex excision. Immediate reconstruction was performed using an LD flap combined with intraoperative fat grafting. Fat harvested from the flanks was purified by decantation and injected during flap insetting into the mastectomy pocket. The postoperative course was uneventful, and the esthetic outcome was satisfactory, with good symmetry and volume preservation. Discussion: The FALD technique demonstrates significant reconstructive potential in selected cases, and performing lipofilling during the same operative session may also help reduce the need for staged revision procedures. This approach may also provide a secondary esthetic benefit by coupling breast reconstruction with body contouring. Despite its demonstrated advantages and favorable safety profile, FALD remains underutilized in current clinical practice. Conclusions: The FALD technique has proven to be a fully autologous, effective, and safe option for immediate breast reconstruction and deserves broader adoption, especially in cases in which implants or free flaps are not desirable or feasible.