Breast reconstruction with the latissimus dorsi musculocutaneous flap.

For breast reconstruction the latissimus flap provides a safe and relatively simple road whose landmarks are familiar to plastic surgeons. These are reviewed. The aesthetic quality of the new breast may depend on a few key planning considerations, one of which is the flap inset site on the anterior chest wall. Theoretic and actual results of using vertical, horizontal, oblique, or curvilinear insets are examined. In many cases ignoring the old scar in favor of a fresh inferolateral curvilinear inset will provide a superior result and is to be strongly considered.