Propeller TAP flap: Is it usable for breast reconstruction?

Abstract

The aim of this study was to examine if a propeller thoracodorsal artery perforator (TAP) flap can be used for breast reconstruction. Fifteen women were reconstructed using a propeller TAP flap, an implant, and an ADM. Preoperative colour Doppler ultrasonography was used for patient selection to identify the dominant perforator in all cases. A total of 16 TAP flaps were performed; 12 flaps were based on one perforator and four were based on two. A permanent silicone implant was used in 14 cases and an expander implant in two. Minor complications were registered in three patients. Two cases had major complications needing additional surgery. One flap was lost due to a vascular problem. Breast reconstruction can be performed by a propeller TAP flap without cutting the descending branch of the thoracodorsal vessels. However, the authors would recommend that a small cuff of muscle is left around the perforator to ensure a sufficient venous return.

Propeller TAP flap breast reconstruction: A simplified surgical technique

“…Since 2011 the propeller TAP flap has increasingly been replacing the classic LD flap in our practice for delayed breast reconstruction where muscle is not required [4][5][6][7][8] . This is largely due to the surgical modifications described in this article.…”

“…In a few cases a small back-cut into the anterior edge of the LD muscle is necessary to enable In the course of time our flap insertion has changed as well. Initially, we inserted the flap where the mastectomy scar was located to replace the missing breast mound 4,5 . However, we have noticed that the best recipient site for the flap is the lateral and inferior part of the intended breast reconstruction.…”

“…We introduced the TAPIA (Thoracodorsal artery perforator flap, implant and acellular dermal matrix) concept, shortly after the introduction of acellular dermal matrix (ADM) in Europe in 2011; a combined use of a propeller TAP flap, an ADM and an implant for delayed breast reconstruction 4,5 . The use of preoperative color Doppler ultrasound (CDU) for perforator localization has enabled us to modify the design of our flap over time 6 .…”

Direct delayed breast reconstruction with TAP flap, implant and acellular dermal matrix (TAPIA)

“…The first eight delayed breast reconstructions were performed with meticulous dissection of the thoracodorsal perforator as previously described in detail by Thomsen et al 26 Hereafter, the technique was modified to a simpler approach. The new surgical procedure was carried out as follows: All patients were screened using color Doppler ultrasonography to identify the most cranially located perforator(s) from the thoracodorsal artery (Video 1).…”

“…26 The goal of combining the TAP flap with an ADM is to create an internal bra supporting the implant and thus preventing any displacement. Furthermore, the ADM works as a substitute of the latissimus muscle to create a biocapsule and it seems to be beneficial for this "shape-and-drape" technique.…”