Use of the Thoracodorsal Artery Perforator (TDAP) Flap With Implant in Breast Reconstruction

Thoracodorsal artery (TDA) flaps, ranging from the vascular-pedicled thoracodorsal artery perforator (TDAP) flap, the propeller TDAP flap, and the muscle-sparing latissimus dorsi (MSLD) flap to the conventional latissimus dorsi (LD) flap and the extended LD flap, can all be used for breast reconstruction. The aim of this paper and review is to share our experiences and recommendations for procedure selection when applying TDA-based flaps for breast reconstruction. We describe the different surgical techniques and our thoughts and experience regarding indications and selection between these procedures for individual patients who opt for breast reconstruction. We have performed 574 TDA flaps in 491 patients: 60 extended LD flaps, 122 conventional LD flaps, two MSLD flaps, 233 propeller TDAP flaps, 122 TDAP flaps, and 35 free contralateral TDAP flaps for stacked TDAP breast reconstruction. All the TDA flaps are important flaps for reconstruction of the breast. The LD flap is still an option, although we prefer flaps without muscle when possible. The vascular-pedicled TDAP flap is an option for experienced surgeons, and the propeller TDAP flap can be used in most reconstructive cases of the breast, although a secondary procedure is often necessary for correction of the pedicle bulk. The extended LD flap is an option for women with a substantial body mass index, although it is associated with the highest morbidity of all the TDA flaps. The MSLD flap can be used if the perforators are small or if dissection of the perforators is assessed to be hazardous.

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A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1735508 ◽

2021 ◽

Author(s):

L. Brambilla ◽

P. Parisi ◽

A. Gatto ◽

D. Codazzi ◽

N. Baronetto ◽

...

Keyword(s):

Soft Tissue ◽

Breast Reconstruction ◽

Latissimus Dorsi ◽

Shoulder Function ◽

Small Sample ◽

Dash Score ◽

Reliable Technique ◽

Thoracodorsal Artery ◽

Tdap Flap ◽

Artery Perforator

Abstract Introduction In breast surgery, an autologous flap combined with implant may reduce the risk or repair the soft-tissue defects in several cases. Traditionally, the preferred flap is the myocutaneous latissimus dorsi (LD) flap. In the perforator flap era, the evolution of LD flap is the thoracodorsal artery perforator (TDAP) flap. The aim of this study is the comparison between LD flap and TDAP flap with implants in terms of early complications and shoulder function. Methods We performed a retrospective cohort study in accordance with the STROBE guidelines. Between January 1 2015 and January 1 2020, 27 women underwent a unilateral total breast reconstruction with LD or TDAP flap combined with an implant at our institution. 15 women were operated with LD flap and 12 with TDAP flap. The most frequent indications for intervention were results of mastectomy and radiation-induced contracture. We evaluated several data in terms of clinical and demographical characteristics, operative and perioperative factors, and follow-up variables. We assessed shoulder function through the Disability of the Arm, Shoulder and Hand Questionnaire (DASH). Results The rate of complications was significantly lower in the TDAP group compared with the LD group (16.7% vs 60.0%, p = 0.047. Table 3). Although the small sample size limited further detailed statistical analyses, we particularly noticed no cases of donor site seroma in the TDAP group, as compared with four in the LD group. Patients in the TDAP group had an ∼11-point lower mean DASH score compared with the LD group (9.8 vs 20.5). This difference was statistically significant (p = 0.049). Conclusions TDAP flap seems to be a reliable technique for soft-tissue coverage in total breast reconstruction with implants. In comparison with the traditional LD flap, it could be a more favorable option in terms of less complications and better quality of life.

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Designing Lateral Thoracic Wall Perforator Flaps for Breast Reconstruction Using the Ultrasound

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1740127 ◽

2021 ◽

Author(s):

Marzia Salgarello ◽

Giuseppe Visconti

Keyword(s):

Breast Reconstruction ◽

Duplex Ultrasound ◽

Free Flaps ◽

Thoracic Wall ◽

Perforator Flaps ◽

Thoracodorsal Artery ◽

The Us ◽

Latissimus Dorsi Myocutaneous Flap ◽

Artery Perforator ◽

Color Duplex Ultrasound

Abstract Background Lateral thoracic flaps represent a precious source for partial and total breast reconstruction, in some cases as first option and in other cases as alternative of free flaps. This article describes the ultrasound (US)-based planning of the lateral thoracic wall perforator adipocutaneous flaps and it reports our experience on 52 consecutive flaps. Patients and Methods From November 2018 to May 2021, 52 consecutive lateral thoracic wall perforator flaps were performed using the US-based method for reconstruction of partial breast defects and total breast reconstruction. High-frequency US was performed in all cases prior to surgery to select the best perforator and design the flap. Results Of the 52 cases, 41 were lateral intercostal artery perforator flaps (78.8%), and 11 were thoracodorsal artery perforator (TDAP) flaps. Of the 11 TDAP flaps, 2 cases were based on the direct cutaneous branch. Moreover, in two other cases clinically scheduled for lateral thoracic perforator flaps due to the presence of an appropriate axillary roll, no suitable local/regional perforators were detected with the preoperative US examination and the latissimus dorsi myocutaneous flap was performed. Conclusion Preoperative planning of these flaps using US speeds the surgery and makes it easier and more efficient. Therefore, it is reasonable that the color duplex ultrasound is the operative surgeon's tool for mapping the lateral thoracic wall perforators and to appropriately plan each flap.

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Immediate nipple reconstruction with thoracodorsal artery perforator flap in breast reconstruction by latissimus dorsi myocutaneous flap in patients with Poland's syndrome

Microsurgery ◽

10.1002/micr.22395 ◽

2015 ◽

Vol 36 (1) ◽

pp. 49-53 ◽

Cited By ~ 6

Author(s):

Jinguang He ◽

Hua Xu ◽

Tao Wang ◽

Yufei Qiao ◽

Yi Zhang ◽

...

Keyword(s):

Breast Reconstruction ◽

Latissimus Dorsi ◽

Myocutaneous Flap ◽

Perforator Flap ◽

Nipple Reconstruction ◽

Thoracodorsal Artery ◽

Poland's Syndrome ◽

Latissimus Dorsi Myocutaneous Flap ◽

Thoracodorsal Artery Perforator Flap ◽

Artery Perforator

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The role of cinematic rendering in pre-operative planning of a thoracodorsal artery perforator flap (TDAP) phalloplasty: a case study

BJR|case reports ◽

10.1259/bjrcr.20180084 ◽

2019 ◽

Vol 5 (2) ◽

pp. 20180084

Author(s):

Carolina Lugo-Fagundo ◽

Hannah Ahn ◽

Devin O’Brien-Coon ◽

Elliot K. Fishman

Keyword(s):

Volume Rendering ◽

Three Dimensional ◽

Perforator Flap ◽

Muscle Involvement ◽

Thoracodorsal Artery ◽

Operative Planning ◽

Flap Design ◽

Tdap Flap ◽

Artery Perforator ◽

Volume Rendering Technique

The thoracodorsal artery perforator (TDAP) flap is a muscle-sparing skin and fat flap that requires precise intramuscular dissection of the thoracodorsal artery perforators in the axillary region. Pre-operative image-based treatment planning is a crucial part of flap design. In this article, we discuss the first-ever reported use of the cinematic volume rendering technique (CVRT) to evaluate the thoracodorsal artery for a TDAP flap phalloplasty in a 49-year-old transgender patient. Cinematic volume rendering technique uses light maps to generate photo-realistic three-dimensional images of the thoracodorsal artery and its perforators. These images aid the surgeon in evaluating optimal perforators and latissimus dorsi muscle involvement for more efficient flap design.

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