Stacked Thoracodorsal Artery Perforator Flaps for Unilateral Breast Reconstruction

The thoracodorsal artery perforator flap is reliable and safe for breast reconstruction, but stacking bilateral thoracodorsal artery perforator flaps for unilateral reconstruction to achieve greater volumes has not been reported. To create a stacked thoracodorsal artery perforator flap, the ipsilateral flap is transferred as an island, and the contralateral flap is transferred as a microvascular free flap. In this article, the authors present their 8-year 14-patient experience with stacked thoracodorsal artery perforator flaps for unilateral breast reconstruction. Patients' ages ranged from 33 to 72 years (mean, 52.6 years). Mean follow-up time was 48.1 months (range, 1 to 98 months). Flaps measured between 22 x 6 cm and 32 x 8 cm and weighed between 110 and 550 g. Two of the island flaps had steatofibrosis of the distal 3 cm, which was resected and closed directly. The rest of the island flaps and all 14 free flaps healed uneventfully. At the time of follow-up, all flaps appeared healthy, and the reconstructed breast had a similar appearance and volume as the contralateral side. The donor areas had almost no functional deficit, and the final scar was aesthetically acceptable, especially when the ascending oblique design was used. This represents the first description of stacked thoracodorsal artery perforator flaps for unilateral breast reconstruction. This novel addition to the reconstructive surgeon's selection of methods is a safe and reliable option for large-volume unilateral breast reconstruction. It allows for symmetry without requiring prostheses or reduction of the contralateral side.