Management of the partial mastectomy defect has become a common entity as a result of the improved popularity and equivalent survival associated with breast conservation therapy (BCT). Numerous reconstructive options have been proposed in select patients following BCT in an attempt to maintain esthetic results. Thirty-nine women underwent simultaneous endoscope-assisted latissimus muscle transfer at the time of resection and were included in this review. The average follow-up was 3.7 years. Patient demographics and tumor characteristics were discussed. Donor site morbidity was acceptable. Tumor recurrence was experienced in 6 patients (15%) following lumpectomy and latissimus reconstruction. Two patients had local recurrence, and 4 had distant recurrence. Thirty-three patients (85%) had no evidence of disease at long-term follow-up. Lumpectomy and latissimus flap transfer was the definitive reconstructive procedure in 33 of the 39 patients (85%). Patients who subsequently required completion mastectomy were easily reconstructed with a TRAM flap or implants. As the management of partial mastectomy defects continues to challenge the plastic surgeon, we are noticing a shift away from immediate simultaneous reconstructions based on arguments regarding the appropriateness from an oncological and reconstructive perspective. Stringent patient selection, confirmation of negative margins, and possibly delaying the latissimus flap transfer will maximize the benefits of this reconstructive modality while limiting the risk.