Propeller TAP Flap Breast Reconstruction – a Simplified Surgical Technique

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Gudjon Leifur Gunnarsson, Jens Holm, Nicolaj Duus, Mikkel Børsen-Rindom, Tina Tos, Camilla Bille, Lisbeth Hölmich, Jens Ahm Sørensen, Jørn Bo Thomsen
BackgroundThe propeller thoracodorsal artery perforator (TAP) flap in combination with a mesh and an implant has replaced the Latissimus Dorsi flap as the first-choice alternative for the DIEP flap for delayed breast reconstruction in our practice. The aim of this paper is to share our experience using the propeller TAP flap for delayed breast reconstruction with a focus on surgical technique.Material and methodsWe performed 123 propeller TAP flaps in 94 women aged 51 (26-71) years. Color Doppler ultrasonography guided propeller TAP flaps with minimal rotation and perforator dissection was used for delayed breast reconstruction using an implant and a mesh.ResultsThe intended delayed breast reconstruction was achieved in 120/123 (98%) cases, 65 unilateral and 29 bilateral. The flaps were raised on one perforator in 51 cases, two in 54 and three in 18 cases. Silicone implants were used for 86 reconstructions, expander 28 cases, Becker implant 6, and no implant three cases. The median implant volume was 300 cc. The median time for surgery was 3,5 hours for unilateral cases and 4 hours for bilalateral. Direct to implant breast reconstructions was used in 92/123 (75%) and two-stage in 28/123 (23%) reconstructions. The follow-up was 1 year and 8 months (two months to 4 years).ConclusionThe propeller TAP flap in combination with a mesh and an implant can safely be used for delayed breast reconstruction. The refined and simple procedure is fast and easy to perform in patients with well calibrated perforators identified by color Doppler ultrasound.