The Use of the Thoracodorsal Artery Perforator Flap in Both Autologous and Implant Based Breast Reconstruction Salvage Surgery

Introduction: Since its introduction by Angrigiani the Thoracodorsal Artery Perforator (TDAP) flap has become a popular choice in partial breast reconstruction for volume replacement. Although mainly used to provide volume, it has also been reported as an adjunct to implant-based breast reconstruction. Methods: Patients undergoing salvage breast reconstruction surgery with the TDAP flap in the last 20 years were identified from the senior author’s logbook and their clinical data collected from EpicTM, the hospital electronic medical records system. Results: Two such patients, aged 44 and 52 years, were identified. The first had “impending failure” of a subpectoral implant reconstruction following severe cutaneous radiation reaction and poor quality soft tissues overlying the implant, coupled with recurrent seromas. The second had partial SIEA abdominal free flap fat necrosis, leading to volume loss, severe cutaneous scarring and significant deformity. The flap dimensions were 10 cm × 25 cm and 8 cm × 25 cm, respectively. They were each based on a single vascular perforator– one arising from the horizontal and the other from the vertical branch of the thoracodorsal vessels. Both flap transfers were successful and resulted in viable reconstructions despite the challenging indications. Discussion and Conclusion: The TDAP flap was successfully used to perform salvage breast reconstruction in both prosthetic and autologous cases which presented with ongoing challenges. We believe our technique of the TDAP flap for tertiary breast reconstruction provides adequate soft tissue replacement with minimal donor morbidity, and advocate that it be considered for difficult salvage cases when other options are not available.