To sever or not the thoracodorsal nerve in latissimus dorsi flap breast reconstruction

In extended autologous latissimus dorsi flaps, where only the patient's own tissue of the back is used to reconstruct the breast, it is particularly important to have a healthy and trophic muscle flap, which maintains its volume as much as possible. Even in muscle-sparing latissimus dorsi flap surgery, where only a vertical strip of muscle is harvested, based on the descending branch of the thoracodorsal vessels, keeping the nerve intact may preserve the muscle volume to guarantee adequate implant coverage, avoiding any shrinkage of the flap.