Optimizing thoracodorsal artery perforator flap outcomes in oncoplastic breast surgery: multidimensional assistive techniques mitigate learning curve and enhance feasibility

This study aims to evaluate the feasibility and postoperative outcomes of the thoracodorsal artery perforator (TDAP) flap in oncoplastic breast surgery (OBS), incorporating multidimensional assistive techniques. We retrospectively analyzed 14 breast cancer patients treated with TDAP flap OBS from May 2020 to August 2023. Patients were divided into two groups: Group A (first 7 cases) and Group B (last 7 cases). Preoperative perforator localization was performed using color Doppler ultrasound and handheld Doppler, with intraoperative comparisons. Blood perfusion was assessed intraoperatively with indocyanine green (ICG) fluorescence imaging and postoperatively with infrared thermal (IRT) imaging. Patient satisfaction was measured using the BREAST-Q scale. Group A had longer operation times (4.05 ± 0.61 h vs. 3.27 ± 0.31 h, P = 0.011) and longer hospitalization (9.14 ± 2.27 days vs. 7.71 ± 1.60 days, P = 0.199). No flap necrosis occurred. Preoperative and intraoperative perforator positions were consistent. ICG imaging showed good flap blood supply; edge trimming improved perfusion in two cases. IRT imaging confirmed good blood perfusion in the first 3 days post-op. BREAST-Q scores for psychological health and sexual satisfaction were lower post-op (P < 0.001), but no significant differences were found in scores for chest physical health, shoulder and back physical health, or breast satisfaction. While TDAP flap surgery involves a learning curve, it is a highly feasible technique for OBS. Multidimensional assistive technologies significantly enhance preoperative perforator localization and intraoperative flap blood perfusion monitoring, thereby improving flap survival rates and patient satisfaction.