Salvaging breast reconstruction: Profunda artery perforator flaps using thoracodorsal vessels

Background: Over the years, the choice of recipient vessels for free flap autologous breast reconstruction has shifted from the thoracodorsal to the internal mammary vessels due to ease of flap inset and predictability of anatomy. However, thoracodorsal vessels are still great recipient vessels, and can be useful, especially in the previously failed or staged autologous breast reconstruction. In this study, we present our experience using thoracodorsal or serratus vessels for profunda artery perforator flaps. Methods: Of the 792 autologous free flap breast reconstruction performed, we identified 12 patients (21 flaps) who underwent reconstruction using thoracodorsal or serratus vessels from 2012 to 2017. Flap, patient characteristics, and demographic data and perioperative details were collected. Results: Twenty-one flaps were used to reconstruct 14 breasts in 12 patients. The mean age of patients was 49.6 years old (range, 42 54), the mean flap weight was 354.7 g (range, 170 540 g), the mean body mass index was 28 (range, 23.2 34.4), and the average operative time was 496.1 minutes (266 680). Majority of these patients underwent additional staged free flap reconstruction (following previous deep inferior epigastric perforator flaps) for severe breast contour defects (58%) and for failed previous breast reconstruction (42%). The anastomosis was performed using thoracodorsal (43%), serratus (43%), and profunda artery perforator side branch (14%) vessels. Conclusion: Determining appropriate flap and recipient vessels in a previously failed or staged breast reconstruction is very challenging. Thoracodorsal and serratus vessels are excellent recipient vessels in patients who already have exhausted internal mammary vessels for previous breast reconstruction.