Thoracodorsal artery perforator (TDAP) flap harvests upper back skin and fat to create the breast(s). This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of already-reconstructed breasts. It yields a relatively long, thin and pliable skin flap and a good aesthetic result. The TDAP flap is a “perforator” flap, thereby leaves the latissimus dorsi muscle (the most commonly harvested muscle in the back region) intact. Preserving the muscle minimizes risks of complications such as seroma or hematoma, down-time after surgery, and the length of time needed for drainage tubes. The level of skill needed to perform a TDAP flap is above that required for a traditional latissimus flap, and therefore it is performed by experienced microsurgeons.
What are the benefits of TDAP flap?
When the breast is reconstructed entirely with your own tissue, the results are generally more natural. As a “stand-alone” flap, however, the TDAP is typically not adequate to provide the volume and contour required for the final result. Therefore, combination with a small implant, or with fat grafting techniques, may be needed in order to optimize the volume and shape of the breast. It is an ideal flap when there is radiation damage to the breast, or if small volumes of tissue are required to contour the breast.
The TDAP flap technique is suited for specialized patients; your surgeon will determine if you are a good candidate.
What will I look like post surgery?
Your plastic surgeon will do everything possible to make your breasts look and feel natural. There will be scars at in the back region as well as on the reconstructed breast, but these tend to be well hidden by standard clothing. Oftentimes patients require a final outpatient surgery after the TDAP flap to make the breasts appear as symmetric and natural as possible. You should discuss with your surgeon all of your concerns and expectations for post-surgery appearance and recovery.
How long will it take to recover?
TDAP flap surgery requires a hospital stay of approximately two days. You will be able to begin eating and you will get out of bed with assistance on the first day after surgery. Typically patients are able to return home on the on the second day. While at home you will be able to perform all necessary activities of daily living.
You will also have two to four surgical drains depending on whether one or two breasts are reconstructed. In most circumstances, these drains will remain in for one to two weeks. If they are highly productive they will stay in longer, though this is unusual.
The recovery time for flap reconstruction is two to four to resume most normal activities. You will be sore for about a week or two and then begin to improve every day. Most patients are able to return to work in two to three weeks after surgery.