Use of the same donor site after prior muscle-sparing latissimus dorsi flap for salvaging implant-based reconstructive failures.

The latissimus dorsi (LD) flap is considered a "lifeboat" in breast reconstruction as it has a proven track record in salvaging implant-based reconstructive failures. As such, it should be used with caution as surgeons have only one opportunity to use this flap and must turn to other more complex autologous options after a conventional LD flap surgery has been previously performed. The author preferentially performs muscle-sparing latissimus dorsi (MSLD) flaps and has found that this allows for future attempts at reconstructive salvage by making use of the residual skin and muscle left behind at the donor site after the initial surgery. Here, we present seven patients who underwent an initial MSLD flap surgery for various reasons and required a return to surgery to harvest the residual soft tissue from the back for reconstructive salvage of their radiated implant-based reconstructions. These findings challenge our previous notions regarding the LD as a flap that can only be used once and suggest a possible advantage for using the MSLD in patients at high risk of reconstructive failure to keep this "lifeboat" available.