Salvaging Breast Reconstruction: Profunda Artery Perforator Flaps Using Thoracodorsal Vessels

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Free flap breast reconstruction techniques have evolved, with a trend towards internal mammary vessels.
• Thoracodorsal vessels remain valuable, particularly for complex cases like failed or staged reconstructions.
• This study investigates the utility of thoracodorsal or serratus vessels for profunda artery perforator flaps.

Purpose of the Study:

• To evaluate the use of thoracodorsal or serratus vessels as recipient vessels in autologous free flap breast reconstruction.
• To assess the outcomes of profunda artery perforator flaps utilizing these alternative vessels.
• To determine the efficacy of these vessels in patients with prior failed or staged breast reconstructions.

Main Methods:

• Retrospective review of 792 autologous free flap breast reconstructions.
• Identification of 12 patients (21 flaps) using thoracodorsal or serratus vessels between 2012 and 2017.
• Collection of flap, patient, and perioperative data.

Main Results:

• Twenty-one flaps were used in 12 patients, with a mean age of 49.6 years and BMI of 28.
• The majority of reconstructions addressed severe contour defects (58%) or failed previous reconstructions (42%).
• Anastomoses utilized thoracodorsal (43%), serratus (43%), and profunda artery perforator side branch (14%) vessels.

Conclusions:

• Selecting recipient vessels is critical in challenging breast reconstructions.
• Thoracodorsal and serratus vessels are excellent recipient options when internal mammary vessels are compromised or unavailable.
• These vessels provide a successful alternative for profunda artery perforator flaps in complex autologous breast reconstruction scenarios.