Total autologous breast reconstruction: A combined approach with kiss LD flap and immediate fat transfer

Background: Conventional Latissimus Dorsi flap usually offers an insufficient amount of skin and volume for breast reconstruction. The Kiss LD flap associated by immediate fat transfer, emerges as a promising total autologous reconstructive option. This method can be offered to those patients who have comorbidities that pose a high risk for microvascular reconstruction or those who simply prefer a simpler and safer reconstructive option. Methods: A Retrospective cohort study was conducted at the National Cancer Institute of Mexico. This study evaluated the use of the combined approach with Kiss LD flap and immediate fat transfer for total autologous breast reconstruction between March 1st, 2023, and February 29th, 2024. The study included demographic variables, (age, gender, and socioeconomic level), clinical variables (cancer staging, body mass index, comorbidities, and reason for selecting the method) and surgical outcomes (timing of reconstruction, laterality of reconstruction, surgery duration, flap dimensions, flap volume, fat graft volume, postoperative complications and postoperative hospital stay days). Results: Fifteen patients with an average age of 42 years (range 31–55 years) undergone total autologous breast reconstruction with Kiss LD flap and immediate fat transfer. The timing of reconstruction was immediate in 80% of patients and delayed in the 20% remaining. The reconstruction was unilateral in 67% of patients and bilateral in 33%. The average surgery time was 145 min (range 117–198). The reasons for choosing this method were categorized in four different groups: patients’ preference for a simpler and safer method (47%), comorbidities that pose a high risk for microvascular reconstruction (33%), salvage of a failed DIEP flap (13%), and not feasible DIEP reconstruction because a previous abdominoplasty (7%). Paddle A measured 20 × 9 cm and Paddle B measured 11 × 4.5 cm. The average volume of the flap and fat transfer was 280 and 120 cc, respectively. No major complications nor total flap loss were registered. Conclusions: The Kiss LD flap associated with immediate fat transfer emerges as an interesting option for total autologous breast reconstruction. This approach presents a safe alternative with an adequate volume in those patients who are not candidates for or do not desire microvascular reconstruction. Level of evidence: Level IV, retrospective cohort study.