D39. TAFF, Tailored Available Flap and Fat Grafting, as an Autologous Option for Total Breast Reconstruction in Ambulatory Setting

PURPOSE: The demand for ambulatory breast reconstruction is rising. Autologous reconstructions are associated with transfers of large tissue flaps, requiring a hospital stay. We present a novel technique of outpatient total autologous breast reconstruction utilizing Tailored Available Flap with Fat grafting (TAFF). METHODS: A retrospective analysis was conducted of all consecutive patients who underwent breast reconstruction using TAFF concept from January 2013-May 2024. TAFF utilizes intra-operatively tailor-tacked lateral chest wall soft tissue islandized on an available perforator coupled with fat grafting. Patient demographics, perforator type, flap skin paddle area, fat grafting volumes, and post-operative outcomes were analyzed. RESULTS: Fifty-six patients with BMI 29.67±6.10 and follow-up of 1.14±0.99 years underwent 99 outpatient breast reconstructions using TAFF. The lateral intercostal (LICAP, 86%) and thoracodorsal artery perforator (TAP, 14%) served as the pedicle. Skin paddle area was 105.98±63.38cm2. Fat grafting was performed 1.7±1.05 times per breast, accumulating to 467.04±352.75 mL. Complications included seroma, fat/flap necrosis, dehiscence, infection, and hypertrophic scarring at follow-up. Eleven LICAP and 2 TAP flaps necessitated re-operation. Prior radiation increased the likelihood of complications requiring reoperation (p=0.03), whereas higher BMI and a history of smoking did not show a significant impact. CONCLUSION: TAFF is an appealing option for ambulatory autologous breast reconstruction with low morbidity and acceptable complication rates. Prior radiation may require different flap choice.