Latissimus Dorsi Flap, TDAP Flap, and ICAP Flap Reconstruction Procedures
Your latissimus dorsi muscle is in your back, just below your shoulder, and behind your armpit. It’s the muscle that helps you do twisting movements, such as swinging a racquet or golf club. Because the flap contains a significant amount of muscle, a latissimus dorsi flap is considered a muscle-transfer type of flap. Although the skin on your back usually has a slightly different color and texture than breast skin, latissimus dorsi flap breast reconstruction can look very natural.
The TDAP flap is taken from the same area of the back as the latissimus dorsi flap. The ICAP flap is taken from the lateral chest wall beneath the armpit. TDAP and ICAP flap procedures are considered muscle-sparing since cutting any muscle is unn. The blood vessels remain connected for both these procedures, so there’s also no need for microsurgery.
The three flaps are:
LAT, or latissimus dorsi, named for the muscle located in the back just below the shoulder and behind the armpit
TDAP, or thoracodorsal artery perforator, named for the blood vessel in the upper back, just behind the breast
ICAP, or intercostal artery perforator, named for the blood vessel under the arm on the side of the body
A LAT flap procedure may make sense for you if:
you don’t have enough belly tissue
you’ve had another type of flap reconstruction surgery that failed and are trying again
you don’t have access to plastic surgeons who can perform the microsurgery that other types of flaps require
The TDAP and ICAP flap procedures may make sense for you if:
you have more fat around the bra line
you’d like to have a corrective procedure after a lumpectomy
What to expect with LAT flap procedures
During a LAT flap procedure, surgeons make an incision in the back near the shoulder blade and take skin, fat, blood vessels, and the latissimus muscle to reconstruct the breast. The flap’s blood vessels remain attached to their original blood supply in the armpit. Surgeons then rotate the muscle from the back to the front of the body so microsurgery may not be needed. But sometimes surgeons may need to cut blood vessels and attach them to the blood vessels in the chest using microsurgery to ensure the flap is positioned correctly.
LAT is considered a muscle-transfer procedure. Surgeons often place an implant under the flap because it is not as thick as other flaps.
The incision for LAT flap surgery leaves a scar on your back. Most surgeons try to place the incision so the scar is covered by your bra strap.
LAT flap procedures take from three to four hours.
What to expect with TDAP and ICAP flap procedures
During a TDAP flap procedure, surgeons make an incision in the upper back just above the bra line and take skin, fat, and blood vessels to reconstruct the breast.
The blood vessels surgeons use for TDAP flaps are the same as those they use for LAT flaps. Like LAT flap surgery, the blood vessels in TDAP surgery remain attached to their original blood supply in the back. ICAP flap surgery is very similar to TDAP flap surgery, except the incision is located under the arm right around the bra line.
TDAP and ICAP flap reconstruction are considered muscle-preserving procedures because surgeons do not cut or remove muscle.
Neither TDAP nor ICAP flap surgery requires microsurgery since surgeons don’t typically have to cut the blood vessels. But sometimes to ensure the flap is positioned correctly, surgeons might have to cut blood vessels and attach them to the blood vessels in the chest using microsurgery.
For more size and volume, these procedures can be combined with:
tissue flaps from other parts of the body
a breast implant that is inserted under the flap
The incision for TDAP and ICAP flap surgery leaves a horizontal scar along the bra line that can be covered up by a bra.
Both TDAP and ICAP flap procedures take from three to four hours.
Recovery from LAT, TDAP, and ICAP flap reconstruction
The LAT, TDAP, and ICAP flap procedures require a hospital stay of about four days. Recovery can take about four weeks.
You may need help taking care of the incision.
After surgery, follow your surgeon’s instructions for:
how to keep the area clean, dry, and protected
when to start stretching exercises and regular daily activities
whether you need a physical therapist to help you strengthen and maintain range of motion in your shoulder
It can take as long as a year or more for your tissue to completely heal and for your scars to fade.
LAT, TDAP, and ICAP flap risks and complications
As with any surgical procedure, LAT, TDAP, and ICAP flap reconstruction surgery has some risk of necrosis, fat necrosis, and muscle weakness.
Muscle weakness and possible partial loss of strength can make it difficult to do pull-ups or activities such as swimming, tennis, or cross-country skiing.
The fat around the latissimus muscle is stiffer than the fat in the abdominal area, which might make the reconstructed breast feel tight. The muscle portion of the flap may also shrink over time, which means the reconstructed breast may lose volume.
This information made possible in part through the generous support of www.BreastCenter.com.
— Last updated on January 3, 2025 at 7:31 PM