The Role of the Rotational Pedicled Latissimus Dorsi Flap in Post-Mastectomy Reconstruction: Indications, Surgical Considerations, Outcomes and Complications

Background: The pedicled latissimus dorsi flap remains one of the most reliable options for breast and chest-wall reconstruction after mastectomy. Although abdominal free flaps and implant-based techniques are widely used, the rotational latissimus dorsi flap continues to offer important advantages in selected patients, particularly when vascularized tissue is needed, when local skin quality is compromised, or when microsurgical options are unavailable or contraindicated.Objective: This narrative review analyzes the current role of the rotational pedicled latissimus dorsi flap in post-mastectomy reconstruction, with emphasis on indications, surgical planning, technical variants, clinical outcomes, complications, and its contemporary position compared with implant-based and perforator-based alternatives.Methods: A structured literature review was performed using PubMed-indexed articles published mainly within the last five years. The search focused on terms related to “latissimus dorsi flap,” “pedicled latissimus dorsi flap,” “mastectomy,” “postmastectomy reconstruction,” “breast reconstruction,” “chest wall reconstruction,” “fat transfer,” “seroma,” “donor-site morbidity,” and “endoscopic latissimus dorsi flap.” Articles were prioritized when they addressed indications, outcomes, technical refinements, fat-augmented reconstruction, implant-assisted reconstruction, salvage procedures, radiotherapy, patient-reported outcomes, and complications.Results: Current evidence supports the latissimus dorsi flap as a versatile reconstructive option for immediate, delayed, secondary, and salvage reconstruction after mastectomy. Its main strengths include a dependable thoracodorsal pedicle, broad arc of rotation, ability to deliver well-vascularized tissue to compromised recipient beds, and compatibility with implants or immediate fat transfer. Modern refinements include muscle-sparing variants, fat-augmented latissimus dorsi reconstruction, endoscopic or scarless harvest, volume-prediction formulas, ERAS pathways, and adjunct regional anesthesia. The most frequent complication remains seroma at the donor site, followed by wound dehiscence, infection, skin-flap necrosis, hematoma, donor-site scar dissatisfaction, shoulder dysfunction, and flap animation.Conclusion: The rotational pedicled latissimus dorsi flap should not be considered an obsolete technique. Rather, it remains a reproducible, safe, and adaptable reconstructive workhorse in selected post-mastectomy patients, particularly in irradiated fields, large soft-tissue defects, implant failure, high-risk patients, and centers without routine microsurgical capability. Its contemporary value depends on careful patient selection, meticulous donor-site management, individualized volume restoration, and prevention of seroma and functional morbidity.