Skip to main content
SpringerLink
Log in

Thoracodorsal Artery Perforator Flap for Partial Breast Reconstruction

  • Chapter
Breast Reconstruction

  • 203 Accesses

Abstract

The popularity of breast conservation therapy (BCT) for the management of women with breast cancer continues to rise. Numerous techniques exist, either at the time of resection or following radiation therapy, and the decision of which to use depends on breast size, tumor size, and tumor location. Women with unfavorable defects will often benefit from volume replacement technique, such as pedicled perforator flaps. The thoracodorsal artery perforator (TDAP) flap is a versatile tool in reconstructive surgery and its use in breast reconstruction is becoming increasingly popular.

Since the original description of TDAP flap by Angrigiani, the location of the majority of perforators 8 cm distal to the posterior axillary fold remains a valid landmark. The ability to safely harvest a TDAP flap is facilitated by precise localization of its perforators. The flap is typically designed as in the classic latissimus dorsi musculocutaneous flap for breast reconstruction but it is outlined more anteriorly to reach the lateral border of the inframammary fold. The main indication is partial breast reconstruction after ablative surgery. The flap reaches the superolateral, inferolateral, and inferomedial quadrants of the breast. The donor site scar can be easily concealed under the brassiere.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 259.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bajaj AK, Kon PS, Oberg KC, Miles DAG (2004) Aesthetic outcomes in patients undergoing breast conservation therapy for the treatment of localized breast cancer. Plast Reconstr Surg 114(6):1442–1449

    Article  PubMed  Google Scholar 

  2. Waljee JF, Hu ES, Newman LA et al (2008) Predictors of breast asymmetry after breast-conserving operation for breast cancer. J Am Coll Surg 206(2):274–280

    Article  PubMed  Google Scholar 

  3. Slavin SA, Love SM, Sadowsky NL (1992) Reconstruction of the radiated partial mastectomy defect with autogenous tissues. Plast Reconstr Surg 90(5):854–865

    Article  PubMed  CAS  Google Scholar 

  4. McCulley SJ, Durani P, Macmillan RD (2006) Therapeutic mammaplasty for centrally located breast tumors. Plast Reconstr Surg 117(2):366–373

    Article  PubMed  CAS  Google Scholar 

  5. Angrigiani C, Grilli D, Siebert J (1995) Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 96(7):1608–1614

    Article  PubMed  CAS  Google Scholar 

  6. Bartlett SP, May JW Jr, Yaremchuk MJ (1981) The latissimus dorsi muscle: a fresh cadaver study of the primary neurovascular pedicle. Plast Reconstr Surg 67(5):631–636

    Article  PubMed  CAS  Google Scholar 

  7. Friedrich W, Herberhold C, Lierse W (1988) Vascularization of the myocutaneous latissimus dorsi flap. Injection study on the thoracodorsal artery. Acta Anat (Basel) 131(12):97–102

    Article  CAS  Google Scholar 

  8. Rowsell AR, Eisenberg N, Davies DM, Taylor GI (1986) The anatomy of the thoracodorsal artery within the latissimus dorsi muscle. Br J Plast Surg 39(2):206–209

    Article  PubMed  CAS  Google Scholar 

  9. Tobin GR, Schusterman M, Peterson GH, Nichols G, Bland KI (1981) The intramuscular neurovascular anatomy of the latissimus dorsi muscle: the basis for splitting the flap. Plast Reconstr Surg 67(5):637–641

    Article  PubMed  CAS  Google Scholar 

  10. Rowsell AR, Davies DM, Eisenberg N, Taylor GI (1984) The anatomy of the subscapular-thoracodorsal arterial system: study of 100 cadaver dissections. Br J Plast Surg 37(4):574–576

    Article  PubMed  CAS  Google Scholar 

  11. Godina M (1987) The tailored latissimus dorsi free flap. Plast Reconstr Surg 80:304–306

    Article  PubMed  CAS  Google Scholar 

  12. Hayashi A, Maruyama Y (1989) The “reduced” latissimus dorsi musculocutaneous flap. Plast Reconstr Surg 84(2):290–295

    Article  PubMed  CAS  Google Scholar 

  13. Tobin GR, Moberg AW, Dubou RH, Weiner LJ, Bland KI (1981) The split latissimus dorsi myocutaneous flap. Ann Plast Surg 7(4):272–280

    Article  PubMed  CAS  Google Scholar 

  14. Rowsell AR, Godfrey AM, Richards MA (1986) The thinned latissimus dorsi free flap: a case report. Br J Plast Surg 39(2):210–212

    Article  PubMed  CAS  Google Scholar 

  15. Russell RC, Pribaz J, Zook EG, Leighton WD, Eriksson E, Smith CJ (1986) Functional evaluation of latissimus dorsi donor site. Plast Reconstr Surg 78(3):336–344

    Article  PubMed  CAS  Google Scholar 

  16. Lee KT, Mun GH (2014) A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer. Plast Reconstr Surg 134(2):303–314

    Article  PubMed  CAS  Google Scholar 

  17. Hamdi M, Decorte T, Demuynck M, Defrene B, Fredrickx A, Van Maele G, De Pypere H, Van Landuyt K, Blondeel P, Vanderstraeten G, Monstrey S (2008) Shoulder function after harvesting a thoracodorsal artery perforator flap. Plast Reconstr Surg 122(4):1111–1117

    Article  PubMed  CAS  Google Scholar 

  18. Heitmann C, Guerra A, Metzinger SW, Levin LS, Allen RJ (2003) The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg 51(1):23–29

    Article  PubMed  Google Scholar 

  19. Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ (2009) The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 124(5):1529–1544

    Article  PubMed  CAS  Google Scholar 

  20. Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40(2):113–141

    Article  PubMed  CAS  Google Scholar 

  21. Taylor GI, Corlett RJ, Shymal CD, Ashton MW (2011) The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flap. Plast Reconstr Surg 127(4):1447–1459

    Article  PubMed  CAS  Google Scholar 

  22. Blondeel PN, Beyens G, Verhaeghe R, Van Landuyt K, Tonnard P, Monstrey SJ, Matton G (1998) Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 51(3):202–209

    Article  PubMed  CAS  Google Scholar 

  23. Giunta RE, Geisweid A, Feller AM (2000) The value of preoperative Doppler sonography for planning free perforator flaps. Plast Reconstr Surg 105(7):2381–2385

    Article  PubMed  CAS  Google Scholar 

  24. Hamdi M, Van Landuyt K, Van Hedent E, Duyck P (2007) Advanced in autogenous breast reconstruction: the role of preoperative perforator mapping. Ann Plast Surg 58(1):18–24

    Article  PubMed  CAS  Google Scholar 

  25. Mun GH, Kim HJ, Cha MK, Kim WY (2008) Impact of perforator mapping using multidetector-row computed tomographic angiography on free thoracodorsal artery perforator flap transfer. Plast Reconstr Surg 122(4):1079–1088

    Article  PubMed  CAS  Google Scholar 

  26. Hamdi M, Van Landuyt K, Monstrey S, Blondeel P (2004) Pedicled perforator flaps in breast reconstruction: a new concept. Br J Plast Surg 57(6):531–539

    Article  PubMed  Google Scholar 

  27. Van Landuyt K, Hamdi M, Blondeel PN, Monstrey S (2004) Autologous breast augmentation by pedicled perforator flaps. Ann Plast Surg 53(4):322–327

    Article  PubMed  Google Scholar 

  28. Spinelli HM, Kink JA, Muzaffar AR (1996) The latissimus dorsi perforator-based fasciocutaneous flap. Ann Plast Surg 37(5):500–506

    Article  PubMed  CAS  Google Scholar 

  29. Guerra AB, Metzinger SE, Lund KM, Cooper MM, Allen RJ, Dupin CL (2004) The thoracodorsal artery perforator flap: clinical experience and anatomic study with emphasis on harvest techniques. Plast Reconstr Surg 114(1):32–36

    Article  PubMed  Google Scholar 

  30. Yang LC, Wang XC, Bentz ML, Fang BR, Xiong X, Li XF, Lu Q, Wu Q, Wang RF, Feng W, He JY, Wang YY (2013) Clinical application of the thoracodorsal artery perforator flaps. J Plast Reconstr Aesthet Surg 66(2):193–200

    Article  PubMed  Google Scholar 

  31. Tseng CY, Lipa JE (2010) Perforator flaps in breast reconstruction. Clin Plast Surg 37(4):641–654

    Article  PubMed  Google Scholar 

  32. Thomsen JB, Bille C, Wamberg P, Jakobsen EH, Arffmann S (2013) Propeller TAP flap: is it usable for breast reconstruction? J Plast Surg Hand Surg 47(5):379–382

    Article  PubMed  Google Scholar 

  33. Hamdi M, Salgarello M, Barone-Adesi L, Van Landuyt K (2008) Use of the thoracodorsal artery perforator (TDAP) flap with implant in breast reconstruction. Ann Plast Surg 61(2):143–146

    Article  PubMed  CAS  Google Scholar 

  34. Lin CT, Huang JS, Yang KC, Hsu KC, Chen JS, Chen LW (2006) Reliability of anatomical landmarks for skin perforators of the thoracodorsal artery perforator flap. Plast Reconstr Surg 118(6):1376–1381

    Article  PubMed  CAS  Google Scholar 

  35. Schaverien M, Wong C, Bailey S, Saint-Cyr M (2010) Thoracodorsal artery perforator flap and latissimus dorsi myocutaneous flap: anatomical study of the constant skin paddle perforator locations. J Plast Reconstr Aesthet Surg 63(12):2123–2127

    Article  PubMed  Google Scholar 

  36. Tsukino A, Kurachi K, Inamiya T, Tanigaki T (2004) Preoperative color Doppler assessment in planning of anterolateral thigh flaps. Plast Reconstr Surg 113(1):241–246

    Article  PubMed  Google Scholar 

  37. Thomas BP, Geddes CR, Tang M, Williams J, Morris SF (2005) The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg 116(3):818–822

    Article  PubMed  CAS  Google Scholar 

  38. Randolph LC, Barone J, Angelats J, Dado DV, Vandevender DK, Shoup M (2005) Prediction of postoperative seroma after latissimus dorsi breast reconstruction. Plast Reconstr Surg 116(5):1287–1292

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic Reconstructive Surgery, Niguarda Ca’ Granda Hospital, Piazza Ospedale Maggiore 3, Milan, 20162, Italy

    Stefano Bonomi M.D. & Fernanda Settembrini M.D.

  2. Department of Plastic Reconstructive Surgery, Galeazzi Orthopedic Hospital, Via Riccardo Galeazzi 3, Milan, 20161, Italy

    Andre Salval M.D.

Authors
  1. Stefano Bonomi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernanda Settembrini M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andre Salval M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefano Bonomi M.D. .

Editor information

Editors and Affiliations

  1. Tustin, California, USA

    Melvin A. Shiffman

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Bonomi, S., Settembrini, F., Salval, A. (2016). Thoracodorsal Artery Perforator Flap for Partial Breast Reconstruction. In: Shiffman, M. (eds) Breast Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-18726-6_83

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-18726-6_83

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18725-9

  • Online ISBN: 978-3-319-18726-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation