Inferior pole breast reconstruction by TDAP flap in post-burn breast contracture

Ebrahiem, Ahmed Ali; Manas, Raj Kumar

doi:10.1007/s00238-019-1504-x

Cited by 4 publications

(6 citation statements)

References 12 publications

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“…Most authors agree that breast releases should be performed as soon as breast tissue shows signs of bulging over non-scarred areas or when early breast mound development is clearly restricted by inelastic scar tissue. 1 , 2 , 11 , 17 , 19 – 22 This strategy aims at correcting the original extrinsic defect, allowing the breast to develop in a natural manner. Moreover, as the tissue within the scarred, inelastic torso grows, ventilation may become compromised in patients with severely contracted breasts.…”

Section: Discussionmentioning

confidence: 99%

“… 42 Popular abdominal flaps include the TRAM and DIEP flaps; however, lack of skin laxity and scars to the lower abdomen may prevent their use. 4 , 22 , 43 Other options reported include a vertically-oriented thoracodorsal artery perforator (TDAP) flap, 2 transverse myocutaneous gracilis flap, 44 , 45 and unconventional flap designs given local deformities, such as the one reported by Boehm et al, which combines a tensor fascia lata with ALT flap. 42 …”

Section: Discussionmentioning

confidence: 99%

“…Moreover, deep injuries in the prepubertal period and burn fascial excision to the chest in any age population may engender amastia. [1][2][3][4][5] The primary objective of postburn breast reconstruction is to restore the natural mammary aesthetic features, as well as symmetry of the NAC and IMF. Additional characteristics that allow for a more natural appearing breast include softness to palpation, restoration of sensitivity, mobility to accommodate in clothing, and gravity-dependent positioning.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, deep injuries in the prepubertal period and burn fascial excision to the chest in any age population may engender amastia. 1 – 5 …”

Section: Introductionmentioning

confidence: 99%

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Postburn breast reconstruction: a scoping review

Gus,

Zhu,

Brooks

2023

Scars, Burns & Healing

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Introduction Postburn breast deformities pose functional and aesthetic concerns for burn patients, particularly when injury occurs before puberty, as normal breast development may be hindered. Postburn breast reconstruction aims at restoration of native anatomic features, as well as re-establishment of symmetry. The objectives of this scoping review are to map the literature on scar management and breast reconstruction, highlighting strategies that are particular to postburn deformities, as well as to establish optimal timing principles. Methods A comprehensive search of the English literature across MEDLINE and EMBASE databases, including the grey literature, was conducted. Literature of all study designs were eligible, provided it discussed the treatment of postburn breast deformities. Results A total of 64 studies were included. The most common study design was case series (58%) followed by retrospective cohorts (28%). Scar contracture release with split thickness skin grafts (26%) and various techniques for nipple-areola reconstruction (22%) were the most common reconstructive procedures. Discussion Scar contracture releases predominate when there is normal breast development under a contracted skin envelope, and should be performed as soon as breast mound development is restricted. Surgical techniques widely used for postmastectomy reconstruction are required for patients with amastia or hypoplastic breasts. Conclusion Given the heterogeneity of defects, availability of donor sites, and patient preference, no standardized guideline is available. Surgeons should combine basic scar management principles with postmastectomy techniques, adapting the surgical approach to features that are particular to thermally injured patients, as well as taking into account ideal timing considerations. Lay Summary Breast deformities secondary to burn scars pose functional and aesthetic concerns for burn patients, particularly when injury occurs before puberty, as normal breast development may be hindered. Postburn breast reconstruction aims at restoration of native anatomic features, as well as re-establishment of symmetry. This literature review aimed at summarizing the available techniques to treat postburn breast deformities, as well as establishing optimal timing guidelines, given these issues may occur at any phase of breast development. When there is breast development under a scarred skin envelope, treatment entails scar contracture release and should be recommended as soon as the diagnosis is established, in order to allow the breast to further develop in an unrestricted manner. When there is absence of breast tissue, surgical techniques widely utilized for breast cancer reconstruction are warranted, and should be delayed until no further breast development is expected. Given the heterogeneity of deformities, availability of donor sites, and patience preference, no standardized guideline is available. Treatment options include several surgical techniques, in addition to non-surgical scar management, and timing considerations must take into account the patient's developmental phase and psychosocial wellness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Moreover, deep injuries in the prepubertal period and burn fascial excision to the chest in any age population may engender amastia. 1 – 5 …”

Section: Introductionmentioning

confidence: 99%

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Postburn breast reconstruction: a scoping review

Gus,

Zhu,

Brooks

2023

Scars, Burns & Healing

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“…The TDAP flap is a fasciocutaneous flap based on musculocutaneous or septocutaneous perforators that arise from the thoracodorsal artery. This flap has been largely used in breast reconstructive surgery for partial or total 19 breast reconstruction after oncological resection, in cases of burn breast, 20 and as implant coverage in alloplastic breast reconstruction. 21 …”

Section: Introductionmentioning

confidence: 99%

Thoracodorsal Artery Perforator Flap in Partial Breast Reconstruction: A Systematic Review

Mangialardi

Baldelli

Salgarello

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Introduction: Breast conserving surgery followed by radiation therapy represents the standard of care for early stage breast cancer. Oncoplastic breast surgery includes several reconstructive techniques essentially summarized in 2 categories: volume displacement and volume replacement procedures. These latest procedures have evolved over time from the use of the entire latissimus dorsi muscle to the use of pedicled perforator flaps, namely the thoracodorsal artery perforator (TDAP) flap. The aim of this article is to provide a comprehensive review of the literature regarding the use of the TDAP flap in partial breast defects. Methods: A literature search was performed via PubMed, Medline, and Cochrane. Studies reporting the use of the TDAP flap after breast conserving surgery were included. Patient characteristics, topography and size of breast defect, flap size and design, number of perforators, and operative time were analyzed. Moreover, aesthetic and functional (shoulder morbidity) results, patient satisfaction, postoperative complications, and donor site morbidity were registered. Results: Twelve articles fulfilled inclusion criteria, and 337 patients were included. All articles except 1 described the use of the TDAP flap for defects in every breast quadrant. The mean weight of resected breast tissue was 97.28 g, and patients with over 20% of volume deficiency were considered eligible for TDAP flap volume replacement. The ellipse-shaped skin paddle (oriented oblique downward, transversal or oblique upward in most cases) was extended over the anterior border of the latissimus dorsi muscle to include possible septocutaneous perforator vessels. Most authors began the dissection from the anterior and caudal border of the flap to reserve the possibility to convert the TDAP to a musculocutaneous flap and check for septocutaneous perforators. Flap size ranged from 4 × 12 to 21 × 9 cm. The mean procedure time was 192.21 minutes. Mean follow-up was 17.42 months. Evaluation by way of a 5-point Likert scale reported overall mean values of over 4 points. Satisfactory outcomes were reported in 92.85%–100% of cases. Patient satisfaction ranged from 80% to 94% of cases. The incidence of seroma (1 case) and “shoulder-related” donor site morbidity was very low. Conclusions: Despite the heterogeneity of the evaluation methods, our review suggested that the use of the TDAP flap in oncoplastic surgery allows for satisfactory aesthetic outcomes and quite high levels of patient satisfaction. The TDAP flap represents an effective and versatile tool that amplifies the oncoplastic surgeon’s arsenal, which allows for satisfactory outcomes.

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Flaps for Breast Reconstruction

Manas,

Gohil

2024

Breast Reconstruction - Conceptual Evolution

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Breast is one important organ of women that not only has functional importance of lactation, but also defines the femininity of a woman. Any lass of breast either partial or total may cause psychosocial impact on women’s life. Thus, in case of loss due to various reasons, plastic surgeons involved in oncosurgery team should offer reconstruction to restore breast volume, size, and self-esteem of patients. The chapter aims to describe the various deformities of the breast following cancer, trauma, burn, and reconstructive options in terms of flaps. The various flaps described for breast reconstruction are LD flap, TRAM flap, DIEP flap, and expander implant techniques. The readers will be able to execute the planning for breast reconstruction knowing the indications and contraindications of using a particular flap, surgical techniques of flap elevations, and post-operative care and management.

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Inferior pole breast reconstruction by TDAP flap in post-burn breast contracture

Cited by 4 publications

References 12 publications

Postburn breast reconstruction: a scoping review

Postburn breast reconstruction: a scoping review

Thoracodorsal Artery Perforator Flap in Partial Breast Reconstruction: A Systematic Review

Flaps for Breast Reconstruction

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