Total Breast Reconstruction using Synthetic Implants covered by Thoraco-Dorsal Artery Perforator Flap (TDAP)

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Abstract

Background
Implant-based breast reconstruction specifically with the thoracodorsal artery perforator (TDAP) flap was used with high success rate in partial breast reconstruction, and recently, we used it instead of latissimus dorsi flap with implant for total breast reconstruction to avoid the complications of latissimus dorsi flap and postradiotherapy complications of implant.
Patients and methods
This prospective study was done in the Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Egypt, from October 2018 to November 2020. A total of 20 patients were enrolled in this study. All patients included had either modified radical, skin-sparing, or nipple-sparing mastectomy with axillary staging, followed by reconstruction using appropriately sized implant with the use of pedicled TDAP flap to cover the inferolateral part of the implant.
Results
We had six (30%) cases with breast sized cup A and 14 (70%) cases with cup size B. The cases with grade I ptotic breast were two (10%) cases, grade II were 16 (80%) cases, and grade III were two (10%) cases. Donor site complications were as follows: wound gap occurred in two (10%) cases, seroma in one (5%) case, and infection occurred in two (10%) cases. Recipient site complications were as follows: partial flap necrosis in two (10%) cases, infection in two (10%) cases, and wound dehiscence in two (10%) cases. Two cases developed persistent infection in the short postoperative period and needed implant removal.
Conclusion
TDAP can be safely used in implant-based breast reconstruction with more versatility, reliability, and low morbidity.

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