title: Extended thoracodorsal artery perforator flap for breast reconstruction.
abstract: A total of 45 patients underwent partial or total autologous breast reconstruction after skin-sparing mastectomy, skin-reducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator (TDAP) flap. The detailed surgical technique with its variations is explained in this report. The propeller, flip-over, conventional perforator, and muscle-sparing flaps have been described and evaluated. The flaps were partially or completely de-epithelialized. The conventional TDAP can be enlarged or "extended" as the traditional latissimus dorsi musculocutaneous (LD-MC) flap by incorporating the superior and inferior fat compartments. It can be referred to as the "extended TDAP flap". This technique augments the flap volume. In addition, this flap can serve as a scaffold for lipofilling to obtain autologous breast reconstruction in medium to large cases. There were two complete failures due to technical errors during flap elevation. Distal partial tissue suffering was observed in four flaps. These flaps were longer than usual; they reached the midline of the back. It is advisable to discard the distal medial quarter of the flap when it is designed up to the midline to avoid steatonecrosis or fibrosis. A retrospective analysis of the 39 flaps that survived completely revealed a satisfactory result in 82% of the cases. The main disadvantage of this procedure is the final scar. The TDAP flap is a reliable and safe method for partial or total breast autologous reconstruction.
authors.affiliation: 1 Chief Division Plastic Surgery Hospital Sanntojanni, University of Buenos Aires, Argentina ; 2 Chief Oncoplastic Surgery Instituto Henry Moore, University of Buenos Aires, Argentina ; 3 Plastic Surgeon Hospital Regional de Mar del Plata, Pcia Buenos Aires, Argentina ; 4 Plastic Surgeon Hospital Santojanni, Buenos Aires, Argentina.
authors.forename: Claudio
authors.initials: C
authors.lastname: Angrigiani
authors.affiliation: 1 Chief Division Plastic Surgery Hospital Sanntojanni, University of Buenos Aires, Argentina ; 2 Chief Oncoplastic Surgery Instituto Henry Moore, University of Buenos Aires, Argentina ; 3 Plastic Surgeon Hospital Regional de Mar del Plata, Pcia Buenos Aires, Argentina ; 4 Plastic Surgeon Hospital Santojanni, Buenos Aires, Argentina.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rancati
authors.affiliation: 1 Chief Division Plastic Surgery Hospital Sanntojanni, University of Buenos Aires, Argentina ; 2 Chief Oncoplastic Surgery Instituto Henry Moore, University of Buenos Aires, Argentina ; 3 Plastic Surgeon Hospital Regional de Mar del Plata, Pcia Buenos Aires, Argentina ; 4 Plastic Surgeon Hospital Santojanni, Buenos Aires, Argentina.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Escudero
authors.affiliation: 1 Chief Division Plastic Surgery Hospital Sanntojanni, University of Buenos Aires, Argentina ; 2 Chief Oncoplastic Surgery Instituto Henry Moore, University of Buenos Aires, Argentina ; 3 Plastic Surgeon Hospital Regional de Mar del Plata, Pcia Buenos Aires, Argentina ; 4 Plastic Surgeon Hospital Santojanni, Buenos Aires, Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Artero
keywords: Extended thoracodorsal artery perforator (TDAP); breast reconstruction; perforator flap