Feasibility and aesthetic outcomes of immediate fat-augmented latissimus dorsi (FALD) flap reconstruction post-mastectomy: a prospective cohort study from a tertiary breast centre

Abstract

Background: Traditional mastectomy often results in aesthetic and psychological concerns for patients. The latissimus dorsi (LD) flap remains a widely used autologous option, especially in Asian women with smaller breast volumes. However, volume deficiency remains a limitation. This study assesses the feasibility and outcomes of fat-augmented LD (FALD) flap reconstruction. Methods: A prospective cohort of 23 patients undergoing immediate or delayed LD flap breast reconstruction with intraoperative autologous fat grafting was recruited between 2019 and 2022. Inclusion criteria included body mass index (BMI) 18.5–30 kg/m² and insufficient flap volume for contralateral breast symmetry. Fat was harvested from the thighs using Body-Jet® system and injected into the LD flap and surrounding tissues. Cosmetic outcomes were assessed using Aesthetic Item Scale (AIS) and Body Image Scale (BIS) at 1, 6, and 12 months postoperatively. Results: Median age was 41 years. Average fat volume injected was 232 mL. Most patients were satisfied with their cosmetic outcomes; however, satisfaction declined slightly over time. The nipple-sparing mastectomy (NSM) group consistently scored higher in AIS compared to skin-sparing mastectomy (SSM). Interrater agreement between patients and assessors was low [intraclass correlation coefficient (ICC) <0.5]. Complications were minimal and manageable. Conclusions: FALD flap reconstruction is a feasible, single-stage procedure with promising cosmetic and patient-reported outcomes, especially in patients unsuitable for larger volume flaps.