Breast-conserving surgery with immediate partial breast reconstruction by using pedicled thoracodorsal artery perforator flap: a 7-year follow-up of 50 women

Abstract

Introduction Thoracodorsal artery perforator (TDAP) flap has been used for more than ten years in the immediate partial breast reconstruction (IPBR) of breast cancer, allowing many patients to maximize reserved autologous breast tissue who do not have indications for breast-conserving surgery (BCS). No large sample size survival data for this operation have been reported worldwide. Methods There are 212 primary breast cancer patients who were prepared to receive BCS with IPBR of pedicled TDAP flaps in our institution from June 2013 to December 2017. Finally, the operations were completed successfully in 50 cases. All patients were female with a median age of 40 years. Results The average diameter of TDAPs measured by Doppler ultrasound before the operation was 1.8±0.6 mm (ranging from 0.6 to 3.3 mm). The average size of the flaps was 15x6 cm. The average time of operations was 282±71 minutes (ranging from 120 to 425 minutes). The drainage tube was removed 4.8±1.9 days after the operation (ranging from 3 to 12 days). All TDAP flaps survived, and the wound complication rate was 4% (2/50). The median follow-up time was 88 (67, 94) months [M (IQR)], with a 5-year ipsilateral breast tumor recurrence (IBTR) rate of 4% (95% CI: 0.1%~9.5%), a 5-year breast cancer free interval (BCFI) of 88.0% (95% CI: 79.0%~97.0%), and a 5-year overall survival (OS) rate of 96.0% (95% CI: 90.5%~99.9%). Conclusion IPBR using pedicled TDAP flaps is a good choice for repairing local breast defects in BCS. The advantages of this surgery are no influence on latissimus dorsi function, few complications in the donor area and good long-term prognosis.