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Sarrami et al. Plast Aesthet Res 2024;11:13 https://dx.doi.org/10.20517/2347-9264.2024.06 Page 7 of 15

Figure 7. Harvested latissimus dorsi flap with lateral thoracic node dissection (arrow).

Outcomes
There are limited high-level studies reporting the use of chimeric LD flaps with vascularized lymph nodes
[5,7]
and even fewer focusing on BCRL treatment . Vibhakar et al. published the first case of total autologous
breast reconstruction with a pedicled LD flap and transfer of lateral thoracic nodes. At 10 weeks postop, the
[28]
patient had a significant volume reduction of 44.4% with a complete resolution of her symptoms . This
result can be backed by a case series from Inbal et al., reporting on 7 patients with BCRL . They utilized a
[4]
muscle-sparing technique to correct minor defects in the axilla with a pedicled fasciocutaneous VLNT. In
their study assessing the use of this chimeric flap, they found a volume differential reduction of 48% at three
[4]
months postop and showed improvement in quality-of-life scores .
Benefits
This provides an excellent chimeric flap option in patients with contraindications to an abdominal free flap
[28]
or had a failed abdominal-based reconstruction [Figure 8] . This technique does not require microsurgical
anastomosis and maintains a reliable blood supply to the muscle and adipofascial tissue.

Pitfalls
Prior to surgery, it should be considered that breast cancer treatment could have disturbed the lymphatics
and blood vessels in the lateral thoracic region. Proper preoperative imaging with ICG is necessary to ensure
viable lymph nodes are available for harvest with no concerning signs of dermal backflow or lymphatic
disruption. Preoperative imaging may help reduce the increased complications associated with lateral
thoracic node dissection [5,27] . In a systematic review by Scaglioni et al. comparing multiple lymph node
transfers, the lateral thoracic nodes had the highest overall complication rate of 18.4% and the highest donor
[29]
site complication rate of 15.8% . These included iatrogenic lymphedema, lymphocele, and long-term pain.
A final consideration is that flap volume alone is often inadequate to provide proper cosmesis. This
reconstruction is traditionally combined with an implant, but Abdou et al. have recently pioneered the use
of immediate fat grafting into the LD flap as a completely autologous option .
[30]

Superficial circumflex iliac perforator flap with inguinal lymph nodes
The superficial circumflex iliac perforator (SCIP) flap has begun to regain popularity . Current research
[31]
supports the use of the SCIP flap for small breast reconstruction [32,33] . The adipocutaneous flap contains
lymphatic channels within the soft tissue, hypothesized to stimulate lymphangiogenesis at the recipient site,
improving lymphatic function [9,34,35] . The SCIP flap can be raised with underlying inguinal lymph nodes to