Background: The Fat-Augmented Latissimus Dorsi (FALD) flap is an autologous flap that combines Latissimus Dorsi (LD) flap with immediate autologous fat transfer (AFT) in order to improve breast reconstruction (BR) volume. In recent years, our team has described the ergonomic FALD flap, an evolution of this technique which helps to achieve a complete BR in a single surgical step. In this long-term study, we analyze morphological variations of the breast after ergonomic FALD flap reconstruction compared to the traditional transverse FALD flap technique. Methods: Between December 2020 and September 2022 we prospectively enroll patients undergoing BR using FALD flap into 2 groups: Group A included ergonomic FALD flap, while Group B included traditional FALD flap. The primary endpoint of the study was to compare the two groups in terms of breast projection (BP), breast width (BW) and breast height (BH), while the second endpoint concerned the analysis of the aesthetic outcomes. Results: 32 FALD flaps (23 patients) were performed for the Group-A and 31 FALD flaps (25 patients) for Group-B. There were no significant differences regarding demographic variables. After propensity score weighting analysis, Group-A showed a statistically significant better breast projection (p<0.0001) compared to Group-B. (6.05 vs 5.60). Final aesthetic analyses showed to be superior in Group-A concerning breast shape (p=0.001) and global score evaluation (p=0.004). Conclusion: The ergonomic FALD flap offers better long-term aesthetic outcomes for autologous BR with higher breast projection compared to the traditional transverse FALD flap.