The Thoracodorsal Artery Perforator Flap: A Powerful Tool in Breast Reconstruction

BACKGROUND: Perforator flap use in breast cancer reconstruction has evolved significantly in the last decade. The authors reviewed their experience and evaluated thoracodorsal artery perforator (TDAP) flap outcomes in breast reconstruction. METHODS: A retrospective chart review was conducted of all women undergoing breast reconstruction between 2012 and 2018. Included were patients who underwent a mastectomy (unilateral or bilateral) with immediate reconstruction or requiring a revision reconstruction with a TDAP flap. Reconstruction for nonmalignant causes were excluded. Patient demographics, risk factors, indications, operative details, and complications were reviewed. Major (partial or total flap necrosis, hematoma, and wound breakdown requiring operative management) and minor (cellulitis, seroma, and minor wound breakdown managed with local wound care) complications were recorded. RESULTS: A total of 138 charts were reviewed for the years 2012 and 2018, and 126 patients met inclusion criteria. Mean patient age was 52.1 years. Mean patient body mass index was 29.1 kg/m 2 . A total of 174 TDAP flaps were performed. The success rate was 98.3 percent. There were three flap losses (all partial). Operable fat necrosis rate was 3 percent. Donor-site morbidity was low at a rate of 1.2 percent. There was no difference in complications between patients who had a history of radiation therapy and those who did not (16.7 and 18.6 percent, respectively; p = 0.829). CONCLUSIONS: This study is the largest series in the literature that highlights the utility of the TDAP flap in breast reconstruction. This flap is a powerful tool that should be considered in patients for whom other reconstructive options have been exhausted or unavailable. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.