Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2021; 48(01): 15-25
DOI: 10.5999/aps.2020.01410
Breast/Trunk
Review Article

Thoracodorsal artery flaps for breast reconstruction–the variants and its approach

Jørn Bo Thomsen 
Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
,
Mikkel Børsen Rindom 
Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
Department of Plastic Surgery, Lillebaelt Hospital, Vejle, Denmark
,
Alberto Rancati 
Instituto Oncologico Henry Moore (IOHM), Universidad de Buenos Aires, Buenos Aires, Argentina
,
Claudio Angrigiani 
Instituto Oncologico Henry Moore (IOHM), Universidad de Buenos Aires, Buenos Aires, Argentina
› Author Affiliations
› Further Information
   Permissions and Reprints

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.

Keywords - Breast - Surgical flaps - Education, medical


Publication History

Received: 21 June 2020

Accepted: 09 September 2020

Article published online:
20 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Comment to this article:

Commentary: Thoracodorsal Artery Flaps for Breast Reconstruction—The Variants and its ApproachArch Plast Surg 2021; 48(01): V2-V2
DOI: 10.1055/s-0043-1777245

 

  • REFERENCES

  • 1 Tansini I. Sopra il mio nuovo processo di amputazione della mamella. Riforma Medica 1906; 12: 757
    Google Scholar
  • 2 Maxwell GP. Iginio Tansini and the origin of the latissimus dorsi musculocutaneous flap. Plast Reconstr Surg 1980; 65: 686-92
    CrossrefPubMedGoogle Scholar
  • 3 Schneider WJ, Hill Jr HL, Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg 1977; 30: 277-81
    CrossrefPubMedGoogle Scholar
  • 4 Hokin JA. Mastectomy reconstruction without a prosthetic implant. Plast Reconstr Surg 1983; 72: 810-18
    CrossrefPubMedGoogle Scholar
  • 5 Godina M. The tailored latissimus dorsi free flap. Plast Reconstr Surg 1987; 80: 304-6
    CrossrefPubMedGoogle Scholar
  • 6 Hayashi A, Maruyama Y. The “reduced” latissimus dorsi musculocutaneous flap. Plast Reconstr Surg 1989; 84: 290-5
    CrossrefPubMedGoogle Scholar
  • 7 Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 1995; 96: 1608-14
    CrossrefPubMedGoogle Scholar
  • 8 Hamdi M, Van Landuyt K, Monstrey S. et al. Pedicled perforator flaps in breast reconstruction: a new concept. Br J Plast Surg 2004; 57: 531-9
    CrossrefPubMedGoogle Scholar
  • 9 Hamdi M, Salgarello M, Barone-Adesi L. et al. Use of the thoracodorsal artery perforator (TDAP) flap with implant in breast reconstruction. Ann Plast Surg 2008; 61: 143-6
    CrossrefPubMedGoogle Scholar
  • 10 Gunnarsson GL, Holm J, Duus N. et al. Propeller TAP flap breast reconstruction: a simplified surgical technique. J Plast Reconstr Aesthet Surg 2018; 71: 1424-31
    CrossrefPubMedGoogle Scholar
  • 11 Jacobs J, Borsen-Koch M, Gunnarsson GL. et al. The versatile extended thoracodorsal artery perforator flap for breast reconstruction. Ann Plast Surg 2016; 77: 396-400
    CrossrefPubMedGoogle Scholar
  • 12 Borsen-Koch M, Gunnarsson GL, Udesen A. et al. Direct delayed breast reconstruction with TAP flap, implant and acellular dermal matrix (TAPIA). J Plast Reconstr Aesthet Surg 2015; 68: 815-21
    CrossrefPubMedGoogle Scholar
  • 13 Thomsen JB, Bille C, Wamberg P. et al. Propeller TAP flap: is it usable for breast reconstruction?. J Plast Surg Hand Surg 2013; 47: 379-82
    CrossrefPubMedGoogle Scholar
  • 14 Nahabedian MY, Momen B, Galdino G. et al. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg 2002; 110: 466-75
    CrossrefPubMedGoogle Scholar
  • 15 Rindom MB, Gunnarsson GL, Lautrup MD. et al. Shoulder-related donor site morbidity after delayed breast reconstruction with pedicled flaps from the back: an open label randomized controlled clinical trial. J Plast Reconstr Aesthet Surg 2019; 72: 1942-09
    CrossrefPubMedGoogle Scholar
  • 16 Angrigiani C, Rancati A, Escudero E. et al. Extended thoracodorsal artery perforator flap for breast reconstruction. Gland Surg 2015; 04: 519-27
    Google Scholar
  • 17 Rindom MB, Gunnarsson GL, Lautrup MD. et al. Shoulder-related donor site morbidity and patient-reported satisfaction after delayed breast reconstruction with pedicled flaps from the back: a comparative analysis. J Plast Reconstr Aesthet Surg 2018; 71: 1108-15
    CrossrefPubMedGoogle Scholar
  • 18 Angrigiani C, Rancati A, Escudero E. et al. Propeller thoracodorsal artery perforator flap for breast reconstruction. Gland Surg 2014; 03: 174-80
    Google Scholar
  • 19 Ayestaray B, Ogawa R, Ono S. et al. Propeller flaps: classification and clinical applications. Ann Chir Plast Esthet 2011; 56: 90-08
    CrossrefPubMedGoogle Scholar
  • 20 Rifaat MA, Amin AA, Bassiouny M. et al. The extended latissimus dorsi flap option in autologous breast reconstruction: a report of 14 cases and review of the literature. Indian J Plast Surg 2008; 41: 24-33
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Chang DW, Youssef A, Cha S. et al. Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg 2002; 110: 751-09
    CrossrefPubMedGoogle Scholar
  • 22 Lohana P, Button J, Young D. et al. Functional recovery after bilateral extended autologous latissimus dorsi breast reconstruction: a prospective observational study. J Plast Reconstr Aesthet Surg 2019; 72: 1060-06
    CrossrefPubMedGoogle Scholar
  • 23 Angrigiani C, Rancati A, Artero G. et al. TDAP: island versus propeller. J Plast Reconstr Aesthet Surg 2016; 69: 506-11
    CrossrefPubMedGoogle Scholar
  • 24 Thomsen JB, Gunnarsson GL. The evolving breast reconstruction: from latissimus dorsi musculocutaneous flap to a propeller thoracodorsal fasciocutaneous flap. Gland Surg 2014; 03: 151-04
    Google Scholar
  • 25 Gunnarsson GL, Borsen-Koch M, Nielsen HT. et al. Bilateral breast reconstruction with extended thoracodorsal artery perforator propeller flaps and implants. Plast Reconstr Surg Glob Open 2015; 03: e435
    CrossrefPubMedGoogle Scholar
  • 26 Perignon D, Qassemyar Q, Benhaim T. et al. From Tansini to Angrigiani: improvement and refinement of the thoracodorsal flap. Ann Chir Plast Esthet 2011; 56: 149-55
    CrossrefPubMedGoogle Scholar
  • 27 Angrigiani C, Rancati A, Artero G. et al. Stacked thoracodorsal artery perforator flaps for unilateral breast reconstruction. Plast Reconstr Surg 2016; 138: 969e-972e
    CrossrefPubMedGoogle Scholar
  • 28 Hamdi M. Oncoplastic and reconstructive surgery of the breast. Breast 2013; 22 Suppl 2: S100-5
    CrossrefPubMedGoogle Scholar
  • 29 Adler N, Seitz IA, Song DH. Pedicled thoracodorsal artery perforator flap in breast reconstruction: clinical experience. Eplasty 2009; 09: e24
    Google Scholar
  • 30 Ortiz CL, Mendoza MM, Sempere LN. et al. Versatility of the pedicled thoracodorsal artery perforator (TDAP) flap in soft tissue reconstruction. Ann Plast Surg 2007; 58: 315-20
    CrossrefPubMedGoogle Scholar
  • 31 Borsen-Koch M, Gunnarsson GL, Sorensen JA. et al. Thermal injury in TAPIA breast reconstruction-thermal injury to thoracodorsal artery perforator flap. Gland Surg 2017; 06: 110-03
    CrossrefPubMedGoogle Scholar
  • 32 Gunnarsson GL, Tei T, Thomsen JB. Color doppler ultrasonography-targeted perforator mapping and angiosome-based flap reconstruction. Ann Plast Surg 2016; 77: 464-08
    CrossrefPubMedGoogle Scholar
  • 33 Lorenzen MM, Gunnarsson GL, Bille C. et al. Visualized bilateral breast reconstruction by propeller thoracodorsal artery perforator flaps. Gland Surg 2019; 8(Suppl 4): S262-70
    CrossrefPubMedGoogle Scholar
  • 34 Ibrahim RM, Gunnarsson GL, Akram J. et al. Color Doppler ultrasonography targeted reconstruction using pedicled perforator flaps: a systematic review and meta-analysis. Eur J Plast Surg 2018; 41: 495-504
    CrossrefPubMedGoogle Scholar
  • 35 Alstrup T, Christensen BO, Damsgaard TE. ICG angiography in immediate and delayed autologous breast reconstructions: peroperative evaluation and postoperative outcomes. J Plast Surg Hand Surg 2018; 52: 307-11
    CrossrefPubMedGoogle Scholar
  • 36 Abdelrahman EM, Nawar AM, Balbaa MA. et al. Oncoplastic volume replacement for breast cancer: latissimus dorsi flap versus thoracodorsal artery perforator flap. Plast Reconstr Surg Glob Open 2019; 07: e2476
    CrossrefPubMedGoogle Scholar
  • 37 Lutringer J, Flipo B, Carles M. et al. Functional impairment and its impact on sporting activities after latissimus dorsi flap breast reconstruction. Ann Chir Plast Esthet 2012; 57: 567-74
    CrossrefPubMedGoogle Scholar
  • 38 Garusi C, Manconi A, Lanni G. et al. Shoulder function after breast reconstruction with the latissimus dorsi flap: a prospective cohort study. Combining DASH score and objective evaluation. Breast 2016; 27: 78-86
    CrossrefPubMedGoogle Scholar
  • 39 Blackburn NE, Mc Veigh JG, Mc Caughan E. et al. The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle for women following mastectomy for breast cancer: a critical review. Eur J Cancer Care (Engl) 2018; 27: e12664
    CrossrefPubMedGoogle Scholar
  • 40 Smith SL. Functional morbidity following latissimus dorsi flap breast reconstruction. J Adv Pract Oncol 2014; 05: 181-7
    Google Scholar
  • 41 Friedman O, Fliss E, Inbal A. et al. Latissimus dorsi flap: a winning hand for breast reconstruction salvage. Isr Med Assoc J 2019; 21: 260-04
    PubMedGoogle Scholar
  • 42 Umar M, Jahangir N, Hughes M. et al. Incidence of shoulder functional morbidity following ipsilateral mastectomy and latissimus dorsi flap reconstruction. Acta Orthop Traumatol Turc 2019; 53: 448-51
    CrossrefPubMedGoogle Scholar
  • 43 Browne JP, Jeevan R, Pusic AL. et al. Measuring the patient perspective on latissimus dorsi donor site outcomes following breast reconstruction. J Plast Reconstr Aesthet Surg 2018; 71: 336-43
    CrossrefPubMedGoogle Scholar