Reverse-flow Thoracodorsal Artery: An Additional Perfusion Strategy for Breast Microsurgical Flaps

Autologous tissue-based techniques, including the most popular abdominal perforator flaps, represent the gold standard for breast reconstruction following mastectomy. In microsurgical breast reconstruction, the axillary and internal mammary vessels are commonly used as recipient vessel systems. The axillary system offers multiple suitable and easily accessible vessels, although postradiation fibrosis or previous surgery may render their dissection challenging, requiring the adoption of alternative perfusion strategies. We report a series of 7 microsurgical breast reconstructions with abdominal perforator flaps, performed between January 2021 and February 2023, based on flap perfusion through retrograde flow from the thoracodorsal artery (TDA). The technique proved valuable in scenarios where axillary vessels were compromised or unavailable and the TDA had been divided, showcasing its potential as an alternative flap perfusion strategy. The availability of the reverse-flow TDA as a recipient vessel provides an additional option for surgeons facing challenges in recipient vessel selection, offering a solution for scenarios involving vessel damage, fibrosis, or unavailability. Furthermore, the reverse-flow TDA might be a valuable source for flap reperfusion in cases of surgical revisions and after failed flap revascularization.