Total Breast Reconstruction Using the Thoracodorsal Artery Perforator Flap TDAP

  • Fabio Santanelli di PompeoEmail author
  • Michail Sorotos


The TDAP is a perforator flap based on the perforators that originate from the thoracodorsal pedicle, and it was first described by Angrigiani et al. in 1995. It offers a well-vascularized skin paddle that can be harvested in several dimensions. Breast surgery is one of the areas where the pedicled TDAP has important applications since in selected cases it can offer total autologous breast reconstruction without the need of an implant. It offers an alternative for patients in whom abdomen-based flaps are high-risk or unavailable options or even more as a primary option in patients with small to medium breast size. The TDAP flap can be applied both for immediate and delayed reconstruction and in cases of radiotherapy. The advantages of this technique include a total autologous breast reconstruction, minimally invasive technique, good aesthetic results, low complication rates, and low-cost surgery.


TDAP flap Breast reconstruction Autologous breast reconstruction Thoracodorsal artery perforator flap Flap surgery Breast cancer Mastectomy Fat grafting Lipofilling 


  1. 1.
    Tansini I. Soprailmionuovoprocesso di amputazionedellamammella. Gass Med Ital. 1906;57:141–3.Google Scholar
  2. 2.
    Longo B, Laporta R, Pagnoni M, Campanale A, Grippaudo FR, Santanelli Di Pompeo F. Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face. Microsurgery. 2015;35(3):177–82.CrossRefGoogle Scholar
  3. 3.
    Santanelli di Pompeo F, Laporta R, Pagnoni M, Falesiedi F, Longo B, Sorotos M. Latissimus Dorsi flap for total autologous immediate breast reconstruction without implants. Plast Reconstr Surg. 2014;134(6):871e–9e.CrossRefGoogle Scholar
  4. 4.
    Germann G, Steinau HU. Breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg. 1996;97:519–26.CrossRefGoogle Scholar
  5. 5.
    Clough KB, Louis-Sylvestre C, Fitoussi A, Couturaud B, Nos C. Donor site sequelae after autologous breast reconstruction with an extended latissimus dorsi flap. Plast Reconstr Surg. 2002;109:1904–11.CrossRefGoogle Scholar
  6. 6.
    Jeon BJ, Lee TS, Lim SY, et al. Risk factors for donor-site seroma formation after immediate breast reconstruction with the extended latissimus dorsi flap: a statistical analysis of 120 consecutive cases. Ann Plast Surg. 2012;69:145–7.CrossRefGoogle Scholar
  7. 7.
    Hokin JA, Silfverskiold KL. Breast reconstruction without an implant: results and complications using an extended latissimus dorsi flap. Plast Reconstr Surg. 1987;79:58–66.CrossRefGoogle Scholar
  8. 8.
    Paolini G, Amoroso M, Pugliese P, Longo B, Santanelli F. Functional sequelae following bilateral mastectomy and immediate reconstruction with latissimus dorsi flap: medium-term follow-up. J PlastSurg. Hand Surg. 2014;48(2):99–103.Google Scholar
  9. 9.
    Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg. 1995;96:1608–14.CrossRefGoogle Scholar
  10. 10.
    Hamdi M, Van Landuyt K, Hijjawi JB, et al. Surgical technique in pedicled thoracodorsal artery perforator flaps: a clinical experience with 99 patients. Plast Reconstr Surg. 2008;121:1632–41.CrossRefGoogle Scholar
  11. 11.
    Moore TS, Farrell LD. Latissimus dorsimyocutaneous flap for breast reconstruction: long-term results. Plast Reconstr Surg. 1992;89:666–72.CrossRefGoogle Scholar
  12. 12.
    Tarantino I, Banic A, Fischer T. Evaluation of late results in breast reconstruction by latissimus dorsi flap and prosthesis implantation. Plast Reconstr Surg. 2006;117:1387–94.CrossRefGoogle Scholar
  13. 13.
    Woerdeman LA, Hage JJ, Hofland MM, Rutgers EJ. A prospective assessment of surgical risk factors in 400 cases of skin-sparing mastectomy and immediate breast reconstruction with implants to establish selection criteria. Plast Reconstr Surg. 2007;119:455–63.CrossRefGoogle Scholar
  14. 14.
    Santanelli di Pompeo F, Laporta R, Sorotos M, et al. Breast implant-associated anaplastic large cell lymphoma. Plast Reconstr Surg. 2015;136(2):144e–51e.CrossRefGoogle Scholar
  15. 15.
    Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105:930–42.CrossRefGoogle Scholar
  16. 16.
    Santanelli F, Longo B, Germano S, Rubino C, Laporta R, Hamdi M. Total breast reconstruction using the thoracodorsal artery perforator flap without implant. Plast Reconstr Surg. 2014;133(2):251–4.CrossRefGoogle Scholar
  17. 17.
    Netter FH. Atlas of human anatomy. Philadelphia: Saunders/Elsevier; 2011. Print.Google Scholar
  18. 18.
    Laporta R, Sorotos M, Longo B, Santanelli di Pompeo F. Tips and tricks to improve clinical and aesthetic outcomes in latissimus Dorsi flap breast reconstruction. J Reconstr Microsurg. 2017;33(EFirst):1–11. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Plastic Surgery UnitSant’ Andrea Hospital, Plastic Surgery “Sapienza,” University of Rome School of Medicine and PsychologyRomeItaly

Personalised recommendations