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 procedure 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 helps 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. The TDAP is an alternative option when 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. Women who may not have enough tissue at just one site to attain their desired breast size may find this to be an option.

In almost every case, a patient can have the TDAP performed as part of an “immediate reconstruction” procedure, done on the same day as mastectomy. It may also be used as its own post-mastectomy procedure, known as “delayed reconstruction.” Almost ALL women are candidates for immediate reconstruction, so speaking with your team about reconstruction before mastectomy is essential.

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

The TDAP can also take place after the initial reconstructive procedure at the time of a “second stage” revision operation. It fills in any significant deficiencies that cannot adequately be 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 functionality of the back muscles.

The TDAP can be transferred as a “free flap” where the blood vessels that supply the fat are cut then reconnected 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 a minimally visible scar line once healed. This placement allows women to feel confident and unrestricted in their activities following surgery.

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

As with any surgery, the risks can be minimized by carefully following your pre-surgical instructions. If you have other medical problems or factors that pose an increased risk, we will 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, your visit to our office will take place 1-2 days before 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 receive foot coverings. The nurse or anesthesiologist will start an IV so fluids and necessary medications may be administered to you. Following these preparations, family members will be allowed to visit with you in the preoperative area.

After your surgery is complete, you will awaken in the recovery room under warm blankets with a dedicated nursing attendant carefully monitoring and keeping you 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. For their individualized comfort a fold-out Murphy bed has been integrated into your room.

Your procedure will be performed in a state-of-the-art operating suite that is part of a fully accredited hospital 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 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 reactions and will subside as your swelling resolves.

INCISION LINES

Scar lines tend to improve in appearance for up to a year and usually fade 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 some return of feeling in the skin will occur.

ACTIVITY

You may resume your normal activities as approved by your surgeon. In most cases, it is best to avoid strenuous activity 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. Your surgeon will recommend you perform gentle stretches for the shoulders beginning in the early weeks after your procedure. You should maintain the full range of motion during that time. Your clinic team can provide specific instructions for the post-mastectomy range of motion exercises as applicable. Patients are generally released to return to all normal activities and work schedules 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 post-discharge stay and on the same flight home to assist you at the airport. Our nursing staff will provide your caregiver’s education during your time with us. Our team is available to you and your assistant 24 hours/day should any questions arise after your discharge 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

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