Latissimus Dorsi with Immediate Fat Transfer versus Abdominally Based Free Flaps

Authors: Spoer DL, Berger LE, Huffman SS, Lava CX, Dekker PK, Ko JA, Truong BN, Towfighi PN, Ghyasi N, Fan KL, Song DH

Affiliations: MedStar Georgetown University Hospital

Journal: Plast Recnostr Surg. Oct 2024.

PMID 38470977

Key Takeaways

• LIFT (Latissimus Dorsi with Immediate Fat Transfer) offers similar patient-reported outcomes (PROs) compared to abdominally based free flaps (Ab-FF) with fewer reoperations and shorter hospital stays.

• LIFT is associated with a higher seroma rate but reduced risk of dehiscence, operative complications, and need for revisions.

• BREAST-Q scores at 1 year were similar across domains between both groups.

• LIFT is a viable alternative for patients unsuitable for microsurgical reconstruction or with contraindications to abdominal based free flaps

Background

Autologous breast reconstruction is favored for long-term satisfaction. While Ab-FFs are considered the gold standard for breast reconstruction, they require microsurgical expertise. LIFT, combining a latissimus dorsi flap with fat grafting, offers autologous reconstruction without the need for microsurgery expertise or abdominal donor site.

Objective

To compare postoperative complications and PROs at 1 year between LIFT and Ab-FF techniques.

Methods

• Design: Retrospective cohort study (2017–2022)

• Patients: 281 total (408 breasts)

  • All patients were primary breast reconstruction and offered both LIFT vs. Ab-FF

  • 70 patients (86 breasts) underwent LIFT

  • 211 patients (322 breasts) underwent Ab-FF (DIEP, MS-TRAM, or SIEA)

• Outcomes: Complication rates, reoperations, and BREAST-Q domains at multiple intervals

Results

• Demographics: LIFT patients were older (56 vs. 53 years; P<0.001) with higher comorbidity index. Ab-FF patients received more adjuvant and neoadjuvant chemo/RTX

• Operative Time: LIFT reduced mean OR time by 113 mins (unilateral) and 96 mins (bilateral)

• Hospital Stay: LIFT had significantly shorter stays (median 1 vs. 3 days; P<0.001)

• Complications:

  • Seroma: Higher in LIFT (19% vs. 4%; P<0.001)

  • Dehiscence & Takebacks: Lower in LIFT (dehiscence 9% vs. 17%; takebacks 0% vs. 6%; P<0.05)

  • Reoperations and Fat Grafting: Lower in LIFT (revision 52% vs. 75%; fat grafting 36% vs. 53%; P<0.01)

• Multivariable Analysis:

  • LIFT independently associated with increased odds of seroma (OR 5.05; P<0.001)

  • LIFT predicted decreased odds of dehiscence (OR 0.37), reoperation (OR 0.37), and fat grafting (OR 0.59)

• BREAST-Q Outcomes: 

  • Survey response from 116/281 (41%) patients

  • Survey given at 1, 3, 6, and 12 months

  • 96/211 (46%) – Ab-FF

  • 20/70 (29%) – LIFT

  • At 12-month mark there was no statistically significant difference between all domains on BREAST-Q data

  • Ab-FF tended to increase with time

  • Physical wellbeing was lower initially for LIFT patients

Conclusion

LIFT offers an effective alternative to Ab-FF with fewer complications, shorter recovery, and comparable satisfaction. It is especially useful for patients in which microsurgery or abdominal flap harvest is not possible.

Strengths and Limitations

• Strengths: Comprehensive multivariable analysis

• Limitations: Retrospective design, incomplete BREAST-Q follow-up (41% response rate). Captures both revision reconstruction and primary reconstruction

Future Directions

Prospective, multicenter trials with broader demographic inclusion and long-term follow-up are needed to validate LIFT’s applicability.

Clinical Relevance

Often considered a salvage option, the LD flap (with fat grafting) enables fully autologous reconstruction without microsurgery, offering comparable patient satisfaction to abdominal free flaps with fewer complications and shorter recovery. These findings suggest LIFT may be underutilized and merits consideration as a first-line option in a broader range of patients.