Abstract
PURPOSE: Muscle-sparing latissimus dorsi (MSLD) flap breast reconstruction offers a minimally invasive alternative to traditional latissimus dorsi flap procedures. By preserving muscle integrity, MSLD aims to reduce morbidity while maintaining esthetic and functional outcomes. This study retrospectively analyzes the outcomes of MSLD breast reconstruction in terms of scapula-humeral function and esthetic satisfaction. METHODS: Ninety patients undergoing MSLD flap reconstruction between January 2017 and February 2022 at the Institut de Cancérologie de l'Ouest, Angers, were included. Data collected included demographics, clinical history, surgical details, post-operative complications, esthetic satisfaction (evaluated by patients and health professionals), and shoulder functionality assessed using the DASH questionnaire. RESULTS: Median follow-up was 3.7 years. Most patients were under 65 years (91.1 %), with a median body mass index of 26 kg/m². Immediate reconstruction was performed in 74 % of cases, with a mean mastectomy weight of 576.7 g. Complications were rare, with a necrosis rate of 3.3 % and reoperation in 5.6 % of cases. Esthetic satisfaction was high, with a median score of 4 (out of 5) from both patients and evaluators. Functional outcomes demonstrated minimal impact on shoulder mobility, with a median DASH score of 11. CONCLUSION: MSLD flap reconstruction is a reliable technique that balances functional preservation with esthetic satisfaction. It is suitable for a diverse patient population and demonstrates low complication rates. Future prospective studies comparing MSLD with prosthetic reconstruction may further confirm its advantages.