Living Tissue Breast Augmentation: Introducing the Microsurgical TDAP Procedure

TDAP stands for thoracic dorsal artery perforator flap. This is a highly effective autologous operation that has been used for decades in breast reconstruction.

It is an operation that uses the patient’s own body tissue taken from the side of the chest. The skin and fat is rotated as a living flap of tissue into the breast area.

This operation, once only used for reconstructive problems, is now being offered for autologous, bilateral, simultaneous breast augmentation.

The Tdap is a perforator flap, which means that the living skin and fat that is used for breast augmentation is harvested upon the blood vessel that supplies it.

The living skin and fat on the lateral chest, underneath the arm and going back towards the spine is isolated on this blood vessel, and the living tissue is mobilized so that it can be placed underneath the breast for augmentation.

The donor area, or the place from which the tissue was harvested, is closed as a straight line horizontally underneath the arm.

Unlike other perforator flaps, this tissue remains attached to the blood vessels that supply it. For this reason, it is a much less complicated and less risky microsurgical procedure than other microsurgical procedures, which detach the living tissue and reattach the blood vessels under a microscope.

Therefore, the flap does not routinely need to be monitored, and the patient does not need to remain in the hospital for an extended period of time.

This operation has significant advantages over traditional cosmetic breast augmentation, which is done using implants.

When using the patient’s own body tissue for breast augmentation, the results are natural and permanent, and there is no need for any foreign material in the body whatsoever.

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As mentioned above, the TDAP flap procedure uses the body’s own tissue for augmentation.

Here’s how it works:

• Harvesting the Tissue: Tissue is taken from the lateral thoracic area, which includes skin and fat. This area is chosen because it often contains a substantial amount of tissue and has a blood supply that can be preserved during the procedure.
• Maintaining Blood Supply: During the TDAP flap procedure, the Dr. Levine carefully separates the tissue from its original site while preserving its blood vessels. This step is crucial because it ensures that the tissue remains viable and receives nutrients and oxygen after being moved.
• Transferring and Repositioning: The tissue is then repositioned to the breast area. The preserved blood vessels allow the transferred tissue to integrate with the surrounding breast tissue, where it continues to receive nourishment and establish new connections. This integration helps the tissue to become part of the breast, providing added volume and a natural appearance.
• Healing and Adaptation: After the transfer, the body’s natural healing mechanisms help secure the new tissue in place. Collagen production and tissue remodeling further integrate the new tissue into the breast. The body adapts by establishing a new blood supply network, ensuring the transferred tissue remains healthy and functional.

In the context of breast augmentation procedures like the TDAP flap, blood vessels play a crucial role in ensuring the success and functionality of the transferred tissue.

Here’s how they contribute:

• Nourishment and Oxygen Supply: Blood vessels deliver essential nutrients and oxygen to tissues. When tissue is transferred during the TDAP flap procedure, preserving its blood supply is vital because it ensures that the tissue continues to receive the nutrients and oxygen needed to survive and function. Without a proper blood supply, the transferred tissue could fail to integrate and thrive in its new location.
• Maintaining Tissue Viability: The blood vessels in the flap help maintain the viability of the tissue during and after the transfer. By keeping the blood vessels intact, the Dr. Levine ensures that the tissue remains alive and functional, preventing necrosis (tissue death) that could occur if the blood supply is compromised.
• Integration with Surrounding Tissue: After the tissue is moved to the breast area, the blood vessels help establish new connections with the surrounding tissues. This process is known as “vascularization.” The existing blood vessels in the breast area begin to connect with the vessels in the transferred tissue, forming a new network of blood supply. This integration is crucial for the long-term success of the augmentation, as it allows the new tissue to become part of the breast and adapt to its new environment.
• Wound Healing and Adaptation: Blood vessels are essential for the healing process. They bring in immune cells and growth factors that aid in wound repair and tissue adaptation. As the tissue heals, the new blood vessels help stabilize the transplanted area, contributing to the overall success and durability of the augmentation.