title: Use of thoracodorsal artery perforator flaps to enhance outcomes in alloplastic breast reconstruction.
abstract: BACKGROUND
  Use of the thoracodorsal artery perforator (TDAP) flap in combination with alloplastic devices has been proven to be a safe method of breast reconstruction. However, preoperative irradiation increases the complication rate and thus some consider preoperative radiotherapy a relative contraindication to alloplastic alone reconstruction. We evaluated the long-term outcomes of patients with preoperative radiotherapy who had delayed alloplastic reconstruction with a TDAP flap.
  
  
  METHODS
  A retrospective analysis of a prospectively maintained database was performed to identify patients who had received a Latissimus Dorsi (LD), a Muscle Sparing Latissimus Dorsi (MSLD), or a TDAP flap plus a tissue expander or implant between 2005 and 2012. Information regarding patients' primary diagnosis, radiation history, prior breast reconstructions, and complications was collected and analyzed.
  
  
  RESULTS
  Sixteen patients who had a total of 16 breast reconstructions with an LD (6) or TDAP/MSLD1 flap (10). Demographic data, device type, co-morbidities and complications were analyzed. The rate of capsular contracture and size asymmetry were higher in the LD group, but there was no difference noted for major complications. Minor complications were also similar between the 2 groups.
  
  
  CONCLUSIONS
  Patients who underwent irradiation before TDAP flap did not have a higher complication rate when compared with patients who had a full LD flap following radiation. By integrating well-vascularized, nonradiated tissue of a TDAP flap in reconstruction, overall complication rate may be minimized and the results are comparable to the generally accepted method of utilizing the entire latissimus dorsi muscle.
authors.affiliation: Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Ill.; and Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Wash.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bank
authors.affiliation: Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Ill.; and Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Wash.
authors.forename: Kelly
authors.initials: K
authors.lastname: Ledbetter
authors.affiliation: Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Ill.; and Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Wash.
authors.forename: David H
authors.initials: DH
authors.lastname: Song