TDAP BREAST RECONSTRUCTION

What is TDAP Breast Reconstruction?

The Thoracodorsal Artery Perforator (TDAP) procedure is an advanced method of reconstruction used to rebuild the breast lost to mastectomy. Living fat is transplanted to the chest from the back where unwanted excess in the “bra line” can be found. This allows for volume and shape in the reconstructed breast while smoothing excess back tissue and lifting the waist. The Center for Restorative Breast Surgery has extensive experience with this technique.

When is the TDAP Breast Reconstruction Technique Used?

The TDAP technique is used to help recreate a soft, natural breast. The TDAP itself is sometimes insufficient in volume to completely restore a breast. In those cases, it can be used in combination with another living-tissue reconstruction (DIEP, SGAP) or with an implant.

The TDAP is ideal for patients who may have a broad back or fatty rolls at the bra line. It is considered when the tummy fat (APEX/DIEP procedure) and hip fat (SGAP procedure) are not available to deliver proper size or shape in the new breast. The TDAP can also be used with another living-tissue reconstruction (DIEP, SGAP) in a “stacked” fashion to provide enough volume for a breast reconstruction made entirely of living fat. This is an option for women who may not have enough tissue at just one site to attain their desired breast size.

In almost every case, the TDAP procedure can be done on the same day as mastectomy; this is known as “immediate reconstruction.” It may also be performed as its own post-mastectomy procedure, which is known as “delayed reconstruction.” Almost ALL women are candidates for immediate reconstruction, so speaking with your team about reconstruction prior to mastectomy is important.

When used with an implant, the TDAP is used to replace damaged, radiated skin while still allowing for an implant-based reconstruction.

The TDAP can also be used after the initial reconstructive procedure at the time of a “second stage” revision operation. It is used to fill in any significant deficiencies that cannot be adequately addressed with fat grafting or other adjustments alone.

What are the Benefits of TDAP Breast Reconstruction?

There are several benefits of the TDAP breast reconstructive technique. The recreation of the breast with soft, warm, living fat is permanent and doesn’t require maintenance imaging or repeat surgeries.

The TDAP procedure evolved from the more traditional “latissimus dorsi muscle flap” or “LAT” flap, which uses both muscle and fat to rebuild the breast. The TDAP procedure uses only fat and does not take any muscle, preserving the full function of the back muscles.

The TDAP can be transferred as a “free flap” where the blood vessels that supply the fat are cut then re-connected in the chest or as a “pedicled flap” where the blood vessels that supply the fat remain connected to their original blood supply.

We place the incision so it can be hidden under the back of a brassiere to ensure that once healed women feel confident and unrestricted in their activities with a minimally visible scarline.

What are the Risks Associated with the TDAP Breast Reconstruction Procedure?

As with any surgery, the risks of surgery can be minimized by carefully following your pre-surgical instructions. If you have other medical problems or factors that increase your risk, we will work with you to educate you on proper preparation and arrange your clinical care regimen to maximize your safety and ensure a successful recovery.

What to Expect Throughout the TDAP Breast Reconstruction Procedure

PRE-SURGERY OFFICE VISIT

In most cases, you will be seen in our office 1-2 days prior to your surgery. At that time, we will go over the planned procedure, review consents, answer any questions you may have, and apply any surgical planning markings as may be required.

The TDAP Breast Reconstruction Operation

When you arrive at the hospital, you will be escorted to the preoperative holding area where you will change into a gown and be given foot coverings. The nurse or anesthesiologist will start an IV so that fluids and necessary medications may be given to you. Family members will be allowed to visit with you in the preoperative area once you are prepared for surgery.

After your surgery is complete, you will awaken in the recovery room under warm blankets with a dedicated nursing attendant at your side. You will be carefully monitored and kept comfortable. Then, you will be transferred to a private inpatient room that is prepared to allow you to rest and recover under the supervision of your attending physician and nurses. One adult caregiver may stay with you overnight during your hospitalization. A fold-out Murphy bed has been integrated into your room for their individualized comfort.

Your procedure will be performed in a state-of-the-art operating suite that is part of a fully accredited hospital that has been recognized by the American College of Surgeons for Excellence in care quality. Highly trained professionals using the most modern equipment and techniques will attend to you. In addition to your surgeons, the surgical team includes anesthesiologists, operating room technicians, nurses, and physician assistants.

Post Operation

You will experience some conditions that are quite common after surgery and may include:

SWELLING/BRUISING

Some mild swelling and bruising are to be expected after surgery and will gradually subside within a few weeks.

DISCOMFORT

Some soreness is normal after surgery, but we will provide medications to maximize your comfort and help speed your recovery. Intermittent muscle spasms and feelings of tightness are normal and will subside as your swelling resolves.

INCISION LINES

Scar lines tend to improve in appearance for up to a year and are usually faded by 12-18 months.

SENSATION

Some numbness in the skin is normal after surgery. Occasionally the recovery of sensory nerves can result in tingling, itching, or mild electrical sensations that come and go. These sensations will resolve over time and are usually accompanied by some return of feeling in the skin.

ACTIVITY

You may resume your normal activities as recommended by your surgeon. In most cases, avoidance of strenuous activity is recommended for 4-6 weeks. As a general rule, most patients can drive between 2-3 weeks after surgery if you are no longer using pain medication and your doctor has cleared you. It is recommended to perform gentle stretches for the shoulders beginning in the early weeks after your procedure. Your clinic team can provide specific instruction for post-mastectomy range of motion exercises as applicable. You should maintain the full range of motion within the early weeks post-operation. Patients are generally released to return to full activities and work schedule between 4-6 weeks after surgery. Your clinic team will provide any necessary documentation for your employer.

Returning Home Post Operation

If you are traveling from out-of-state or internationally for care with us, your caregiver will need to be with you throughout your stay post-discharge and on the same flight home to assist you in the airport. Your caregiver’s education will be provided by our nursing staff during your time with us and our team is available to you and your assistant 24 hours/day should any questions arise after you are released from the hospital. Your arrangements for assistance after surgery should include an estimated week to ten days of availability from your caregiver.

We Are Here For You

Be reassured that you are being attended to by some of the most highly skilled and dedicated healthcare providers in the world. Do your best to relax knowing that we are going to take excellent care of you from the moment you enter our facility. We encourage you to ask for any special needs you may have.