J Reconstr Microsurg 2022; 38(06): 451-459
DOI: 10.1055/s-0041-1735508
Original Article

A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

Leonardo Brambilla
1   Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ospedale San Gerardo - ASST Monza, Monza, Italy
,
P. Parisi
1   Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ospedale San Gerardo - ASST Monza, Monza, Italy
,
A. Gatto
1   Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ospedale San Gerardo - ASST Monza, Monza, Italy
,
D. Codazzi
2   Plastic Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
,
N. Baronetto
1   Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ospedale San Gerardo - ASST Monza, Monza, Italy
,
R. Gilardi
1   Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ospedale San Gerardo - ASST Monza, Monza, Italy
,
R. Giovanazzi
3   Department of Oncologic Breast Surgery – Breast Unit, Ospedale San Gerardo - ASST Monza, Monza, Italy
,
A. Marchesi
1   Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ospedale San Gerardo - ASST Monza, Monza, Italy
› Author Affiliations

Abstract

Background In breast surgery, an autologous flap combined with implant may reduce the risk or repair the soft-tissue defects in several cases. Traditionally, the preferred flap is the myocutaneous latissimus dorsi (LD) flap. In the perforator flap era, the evolution of LD flap is the thoracodorsal artery perforator (TDAP) flap. The aim of this study is the comparison between LD flap and TDAP flap with implants in terms of early complications and shoulder function.

Methods We performed a retrospective cohort study in accordance with the STROBE guidelines. Between January 1 2015 and January 1 2020, 27 women underwent a unilateral total breast reconstruction with LD or TDAP flap combined with an implant at our institution. 15 women were operated with LD flap and 12 with TDAP flap. The most frequent indications for intervention were results of mastectomy and radiation-induced contracture. We evaluated several data in terms of clinical and demographical characteristics, operative and perioperative factors, and follow-up variables. We assessed shoulder function through the Disability of the Arm, Shoulder and Hand Questionnaire (DASH).

Results The rate of complications was significantly lower in the TDAP group compared with the LD group (16.7% vs 60.0%, p = 0.047. [Table 3]). Although the small sample size limited further detailed statistical analyses, we particularly noticed no cases of donor site seroma in the TDAP group, as compared with four in the LD group. Patients in the TDAP group had an ∼11-point lower mean DASH score compared with the LD group (9.8 vs 20.5). This difference was statistically significant (p = 0.049).

Conclusions TDAP flap seems to be a reliable technique for soft-tissue coverage in total breast reconstruction with implants. In comparison with the traditional LD flap, it could be a more favorable option in terms of less complications and better quality of life.

Note

Never presented, partially or totally, at previous meetings.




Publication History

Received: 27 October 2020

Accepted: 09 August 2021

Article published online:
07 September 2021

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