title: TDAP: Island versus propeller.
abstract: OBJECTIVE
  Thoracodorsal artery perforator (TDAP) island flap is a safe and reliable method for breast reconstruction. TDAP propeller flap has been described as a modification of the conventional island technique that saves time and does not require microsurgical skills. However, a substantial portion of the propeller flap remains under the axilla and is not used for breast augmentation. The aim of this study is to identify the differences in the reaching distances between the propeller and island TDAP flaps.
  
  
  METHODS
  In five cadaveric specimens and 10 breast reconstruction patients, an initial propeller flap was harvested and rotated to the anterior thorax; the distance from the tip of the flap to the anterior midline was recorded as the "midline-reaching deficit;" the flap was then converted into a conventional island flap, and the new midline-reaching deficit was recorded. Differences between groups were compared with paired two-tailed t-tests (α = 0.05).
  
  
  RESULTS
  In the cadaveric specimens, the mean midline-reaching deficit was 4.8 ± 2.4 cm with the propeller TDAP and -0.6 ± 2.0 cm with the conventional island TDAP (P < 0.001). In the clinical cases, the mean midline-reaching deficit was 8.1 ± 1.0 cm with the propeller TDAP and -0.3 ± 1.1 cm with the island TDAP (P < 0.000000001).
  
  
  CONCLUSIONS
  We observed that the midline-reaching deficit could be reduced by 7-9 cm with the conventional island TDAP in comparison to the propeller TDAP. This should be considered when reconstructing the medial inner part of the breast.
authors.affiliation: Divison of Plastic Surgery, University of Buenos Aires School of Medicine, Viamonte 430 St, Buenos Aires, Argentina.
authors.forename: Claudio
authors.initials: C
authors.lastname: Angrigiani
authors.affiliation: Division of Plastic Surgery, Instituto Henry Moore, Aguero 1248, Buenos Aires, Argentine.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rancati
authors.affiliation: Divison of Plastic Surgery, University of Buenos Aires School of Medicine, Viamonte 430 St, Buenos Aires, Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Artero
authors.affiliation: Division of Plastic Surgery, Hospital Interzonal General de Agudos, Av Juan Bautista Justo 670, Mar de Plata, Argentina.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Escudero
authors.affiliation: Office of Medical Student Education, University of Michigan Medical School, 1113 Freesia Ct, Ann Arbor, MI, USA. Electronic address: rkkhouri@med.umich.edu.
authors.forename: Roger K
authors.initials: RK
authors.lastname: Khouri
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery; D002102:Cadaver; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply*; D013895:Thoracic Arteries
keywords: Breast reconstruction; Island TDAP; Propeller TDAP; TDAP; Thoracodorsal artery perforator