TAP Flap

Located in the same region as the latissimus dorsi flap, the thoracodorsal artery perforator flap (TAP flap or TDAP flap) is a small flap that utilizes the tissue from the area on the side of the breast and the back. This flap is an option for small defects, such as in breast conservation or lumpectomy patients.

Most patients do not have enough tissue on the upper back to use TAP flaps alone in breast reconstruction after mastectomy. However, they can be a good supplemental source for augmenting the contour and adding volume to already reconstructed breasts. The TAP Flap may also be used in combination with a small implant or fat grafting techniques to enhance the shape and size of the breast.

Unlike the latissimus dorsi flap, this flap preserves the back muscle. The TAP flap is what’s known as a ‘perforator flap’, meaning only skin and fat are harvested for the procedure and the muscle is left intact. With a latissimus flap, part of the back muscle is also used for reconstruction, which can potentially limit movement in activities that require pushing off with the arm such as climbing or swimming.

The TAP flap can be rotated from the upper back and positioned on the chest wall to use in partial breast reconstruction or to help correct a lumpectomy “dent”. The TAP flap contains skin and subcutaneous fat that lies over the latissimus dorsi muscle, but includes a perforating vessel that is attached to the thoracodorsal artery. Tiny blood vessels are carefully isolated and dissected from the muscle so as to preserve the LD muscle as well as the blood supply.

The surgical time investment is greater with the TAP flap when compared to more traditional flap reconstruction procedures that sacrifice muscle. However, the benefits of preserving the muscle are often worth it, especially for active, athletic women. The resulting scar from TAP flap surgery can usually be placed horizontally and is well hidden in the bra strap line.