Partial Mastectomy Reconstruction with Pedicled Thoracodorsal Artery Perforator Flap

Abstract

Partial breast reconstruction is required in most of the cases of partial mastectomies to avoid post Breast Conserving Therapy (BCT) breast deformity or in those cases of partial or total free flap failure for breast reconstruction, as a salvage procedure.

There are two main categories of surgical techniques in partial breast reconstruction: volume displacement and volume replacement. Among the volume replacement techniques, pedicled perforator flaps are the first choice.

This case illustrates a salvage partial breast reconstruction in a woman who underwent previous left mastectomy and immediate DIEP flap breast reconstruction. Due to massive liponecrosis of the flap, the patient developed a soft-tissue deficiency in the lower pole.

The patient underwent a two-stage procedure. The first stage involved the restoration of the missing tissues with a thoracodorsal artery perforator (TDAP) flap. The TDAP flap provides good number of soft tissues, sparing the latissimus dorsi muscle and minimizing the seroma formation rate. A contralateral breast symmetrization was also performed.

After 3 months, the patient received secondary procedures to refine the breast reconstruction. Lipofilling of the medial poles, revision of the horizontal scar and the nipple areola complex reconstruction were performed. The recovery was uneventful. At 1 year follow-up the patient showed a satisfactory aesthetic result and no impairment at the donor site.