The fat-augmented latissimus dorsi (FALD) flap is an autologous flap that combines the latissimus dorsi (LD) flap with intraoperative autologous fat transfer (AFT) to improve the volume of the reconstructed breast. In recent years, our team has described the ergonomic FALD flap, a modification of this technique that helps to achieve a complete reconstruction in a single surgical step. In this case-control study, we analyze the long-term morphological changes of the breast after ergonomic FALD flap reconstruction compared with the traditional FALD flap technique.

Between December 2020 and April 2023, we prospectively enrolled patients undergoing BR using FALD flap into two groups: group A included ergonomic FALD flap, while group B included traditional FALD flap. The primary endpoint was to compare the two groups in terms of breast projection, breast width, and breast height, while the second endpoint concerned the analysis of the aesthetic outcomes.

Forty-two FALD flaps (31 patients) were performed for group A and 37 FALD flaps (29 patients) for group B. The two groups were homogeneous regarding demographic variables. Using a propensity score weighting analysis, group A showed a significantly higher breast projection compared with group B (6.78 vs. 5.75; p < 0.0001), after 18 months of follow-up. Final aesthetic analyses showed to be superior in group A concerning breast shape (p = 0.003) and global score evaluation (p = 0.023).

The ergonomic FALD flap showed better long-term aesthetic outcome compared with the traditional transverse FALD flap, with higher breast projection and fewer additional delayed AFT sessions. The study provides level II evidence.

The study was conducted in accordance with the tenets of the Declaration of Helsinki. All patients were duly informed and signed a specific informed consent on the procedure before the surgery.

Received: 17 September 2025

Accepted after revision: 25 February 2026

Accepted Manuscript online:
06 March 2026

Article published online:
24 March 2026

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