With the increasing use of skin-sparing mastectomies, oncoplastic procedures, and immediate reconstructions, the autogenous latissimus breast reconstruction has experienced a resurgence of interest. The "autogenous latissimus flap" refers to self-derived composite of muscle, fat, and skin. This concept is based on the ability of the latissimus muscle to "carry" fat on its surface. This composite of fat and muscle is extremely helpful in several ways. It adds volume, which may be adequate to replace the breast shape without using an implant. It is also an ideal local tissue replacement for oncoplastic procedures and the correction of irradiation fibrosis. The autogenous latissimus flap further serves as a "backup" flap for microvascular and TRAM flap breast reconstructions, when there is partial or complete flap loss. Finally, the autogenous latissimus flap can be used to create an aesthetic breast both with and without an implant. The latissimus muscle is an "expendable" muscle, in the sense that its loss of function is seldom noticed. The primary concern about functional loss is in the motion of "pushing off" with a ski pole.1
Iginio Tansini, a professor of surgery at the University of Padua in Padua, Italy (Fig. 80-1), described the first latissimus musculocutaneous flap in 1896.2 He used the island latissimus flap to reconstruct the radical mastectomy defect with "like" tissue (Fig. 80-2). "Besides healing the wound … the flap is of considerable thickness and succeeds in providing an even better repair to the loss of matter, substituting the latissimus dorsi muscle for the pectoralis major muscle."3 Tansini's contribution of the concept of the "island" latissimus flap, which "carried" the overlying skin, was a new concept. His goal was to repair the radical mastectomy defect by replacing both the lost skin and the pectoralis muscle. This "Tansini Method of Mastectomy" included radical removal and replacement of most of the breast skin and the pectoralis major muscle, and replacing the lost tissue with the latissimus dorsi musculocutaneous flap.3 In Europe this became the most common method of obtaining a healed wound in the radical mastectomy defect during the first 2 decades of the 20th century.
Iginio Tansini, Professor of Surgery, Padua, Italy. (From Athena rassegna mensile di biologia—clinical terapia. Anno VII. 1938;1:65.)
Tansini's latissimus island flap, 1906. [From Tansini I. Sopra il mio nuovo processo di amputazione della mamella. Riforma Medica (Palermo, Napoli). 1906;12:757.]
In his grand tour of Europe in 1920, as America's first professor of surgery and most eminent surgeon, William S. Halsted objected to the use of a flap reconstruction at the time of mastectomy because of his fear that the latissimus flap might obscure diagnosis of breast cancer recurrences. Halsted advocated the use of skin grafts or secondary epithelialization ...