title: ITADE flap after mastectomy for locally advanced breast cancer: A good choice for mid-sized defects of the chest wall, based on a systematic review of thoracoabdominal flaps.
abstract: BACKGROUND
  Locally advanced breast cancer (LABC) is still a common problem in developing countries. Extensive resections are aimed at local control and improving quality of life. Dermofat flaps are an option for medium-sized defects.
  
  
  OBJECTIVE
  Evaluate the results of a new thoracoabdominal flap (TAF).
  
  
  METHODS
  We describe and evaluate an ipsilateral, thoracoabdominal horizontal, dermofat (ITADE) flap performed in patients submitted to mastectomy and immediate reconstruction. A systematic review of the flaps used in this situation was performed.
  
  
  RESULTS
  A total of 23 patients underwent the ITADE flap. The average flap size was 360 cm2. One (4.3%) patient presented extensive loss of the flap. In the literature review, we observed 354 patients with 159 TAFs. We added our cases to the evaluation. A significant reduction in the risk of necrosis using myocutaneous flaps versus TAFs was observed (P < 0.001). Comparing other TAFs and ITADE flaps, considering all necrosis, a significant difference was apparent (P = 0.02), which disappeared when evaluating only larger necrosis (P = 0.13). Multivariate analysis showed that the resected area was the best variable related to the presence of necrosis.
  
  
  CONCLUSIONS
  ITADE allows extensive coverage areas, an early start of adjuvant treatment and it can be performed without requiring a reconstructive team.
authors.affiliation: Postgraduate Program in Oncology, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.|Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.
authors.forename: René Aloisio da Costa
authors.identifier: http://orcid.org/0000-0003-2014-9016
authors.initials: RADC
authors.lastname: Vieira
authors.affiliation: Postgraduate Program in Oncology, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.|Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.
authors.forename: Katia Mathias Teixeira
authors.initials: KMT
authors.lastname: da Silva
authors.affiliation: Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.
authors.forename: Idam
authors.initials: I
authors.lastname: de Oliveira-Junior
authors.affiliation: Center of Epidemiology and Statistics, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.
authors.forename: Marcos Alves
authors.initials: MA
authors.lastname: de Lima
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps; D035441:Thoracic Wall / Q000601:surgery
keywords: breast cancer; locally advanced breast cancer; mastectomy; surgical flaps; thoracoabdominal flaps