LD flaps
In LD (latissimus dorsi) flap procedures, a flap containing skin, fat, and muscle is lifted from the back, just beneath the shoulder blade. The tissue flap is rotated and tunneled under the skin to the breast reconstruction site, where it’s formed into the new breast. The blood thoracodorsal blood vessels that feed the new breast aren’t severed, so microsurgery isn’t necessary. Because muscle is taken from the back, long-term muscle weakness may result.
Unless the new breast is very small, or there is plentiful back fat, many patients require breast implants together with the LD flap tissue for sufficient breast volume and projection.
TDAP flaps
The TDAP (thoracodorsal artery perforator flap) is a more complicated procedure than the LD flap. In the TDAP, tiny blood vessels are carefully separated from the back muscles so that the muscle itself doesn’t need to be removed. That means there is less postoperative pain and no long-term muscle weakness to contend with.
The incision is made in the same area of the back as in the LD flap. When the tiny blood vessels have been separated from the back muscles, the flap, containing the blood vessels, fat, and skin, is lifted from the back, rotated, and tunneled under the skin to the breast reconstruction site. As in the LD flap, no microsurgery is necessary because the flap retains its original blood supply. TDAP flaps are smaller than LD flaps and are usually used for partial breast reconstruction after lumpectomy or to correct deficiencies after total breast reconstruction.