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Types of oncoplastic breast surgery: LTAP flap

Types of oncoplastic breast surgery: LTAP flap

A breast conservation procedure is sometimes used in breast cancer surgery to remove only the tumour and some of the surrounding breast tissue. Such methods are favourable to mastectomies and total breast reconstructions in early stage breast cancer because they allow cancer patients to retain their natural breast shape and sensation while minimising the risk of complications.

Oncoplastic surgery breast conserving approaches involve immediate partial breast reconstruction following tumour removal, using breast reduction/lifting techniques derived from plastic surgery or flap replacement of the tumour defect.

This guide will focus on one type of oncoplastic breast surgery: the lateral thoracic artery perforator flap reconstruction, or LTAP flap for short. We will explain what this procedure involves, its benefits and limitations, as well as who is and is not the ideal candidate for this operation.

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What is LTAP flap surgery?

The LTAP flap method involves using a flap of tissue from the lateral chest wall which is supplied with blood from the lateral thoracic artery to fill the gap left by the removal of a cancerous tumour in the lateral or central breast area.

The lateral thoracic artery is identified with a Doppler during surgery planning, and is present in about 95% of cases. Until the LTAP vessel has been identified, your surgeon cannot guarantee that they can conduct the surgery. Because of the position of the LTAP vessels, they are often incorporated into lateral intercostal artery perforator surgery, or LICAP flap surgery as another option.

The LTAP flap procedure is an effective way of replacing tissue lost due to tumour removal in order to maintain a natural breast size and shape. Stephen McCulley is an expert in this field of oncoplastic breast conserving surgery. This and other oncoplastic techniques like the LICAP flap reconstruction are the methods of choice for small or partial breast defects for which flaps requiring larger volumes of tissue, such as the latissimus dorsi (LD) flap, would not be appropriate.

What are the benefits of LTAP flap surgery?

A major benefit of LTAP flap surgery is that cancer removal and breast reconstruction is performed in one procedure. This means that patients don’t have to face multiple surgeries and recovery periods. Compared to alternative reconstruction methods, such as the mini LD flap, LTAP flap surgery does not remove any muscle from the back while still achieving good symmetry between the breasts.

LTAP flap surgery is preferable over a mastectomy followed by a total breast reconstruction, which often negatively affects breast and nipple sensation. Although sensation is affected temporarily following LTAP flap surgery, normal sensation is restored in many cases as the tissue heals. Furthermore, full mastectomies tend to result in major scarring of the breasts, while most scarring left by LTAP flap surgery is limited to the armpit area and any scarring on the breast itself can usually be hidden in the bra line.

Unlike the LD flap, there are no muscles involved in LTAP flap surgery. While there may be some stiffness or tightness in the reconstructed area after the procedure and during recovery, shoulder movement and function will only be affected temporarily and not severely inhibited. By avoiding the use of muscle in LTAP flap breast reconstruction there are fewer risks of long-term complications and recovery time is significantly reduced.

What are the limitations of LTAP flap surgery?

Most patients are usually still advised to have radiotherapy following LTAP flap surgery. Appearance and patient satisfaction is generally excellent for this operation, but there is a chance the breasts may shrink or change shape slightly after radiotherapy.

Like all reconstructive surgeries, the LTAP flap procedure comes with a low risk of infection and problems with wound healing during recovery. Haematoma, deep vein thrombosis, fat necrosis and loss of blood supply to the flap are all potential complications to be aware of, although very rare.

LTAP flap surgery is a less invasive solution than other types of reconstructive breast cancer surgeries, such as full mastectomies and LD flap surgery. However, there is still a significant recovery period following the procedure and the breasts will feel painful, numb or swollen for several weeks afterwards.

Who is a good candidate for LTAP flap surgery?

LTAP flap surgery is best suited to patients who have tumours located in the outer (lateral) or central portion of the breast. It is particularly useful when tumours occupy more than 10% of the breast volume and lumpectomy is therefore likely to leave the breast deformed.

In patients with ptotic (very large or droopy) breasts, LTAP flap surgery might not be the most suitable option. In these cases, it is usually favourable to use a therapeutic mammoplasty, which involves re-arranging the breast tissue to fill the space left by the removed tumour.

Frequently asked questions

How will my reconstructed breasts feel immediately after LTAP flap surgery?

Your breasts will likely feel sore after LTAP flap surgery, but this initial pain will be managed by your plastic surgeon via local anaesthesia and anti-inflammatory drugs. It is normal for swelling to occur in the days following surgery and this can last for several weeks, leading to the breasts feeling heavy and uncomfortable. Your surgeon will recommend appropriate pain relief during recovery to help you feel as comfortable as possible.

How long will I stay in hospital after LTAP flap surgery?

Most patients can be done as a day-case although occasionally need to stay in the hospital for just one night after LTAP flap surgery.

What is the recovery period like for LTAP flap surgery?

Full recovery from LTAP flap surgery tends to take between four and six weeks. The first week following surgery is likely to be the most uncomfortable as the breasts will be swollen and bruised, and you’ll likely feel tired from the anaesthesia. It is important to avoid strenuous activity for at least six weeks after surgery and you may need to take this period of time off work depending on the nature of your job.

You will likely be unable to drive for three weeks, or until you have regained adequate mobility to perform a safe emergency stop. Some swelling and bruising of the breasts can last for several months after surgery, even after you have recovered and healed. It can take between six and 12 months for breast shape and scars to fully settle.

For more information or advice about your breast cancer surgery options, contact the Stephen McCulley team today.