Donor site morbidity associated with thoracodorsal artery flap breast reconstruction: a narrative review

Objective: The aim of this paper is to give an overview of the available evidence on shoulder-related morbidity associated with the thoracodorsal artery (TDA) flaps when used for breast reconstruction. Background: The pedicled TDA flaps are well described for breast reconstruction with the myocutaneous latissimus dorsi (LD) flap being the standard procedure. This flap is well described and considered a safe and reliable reconstructive method. However, use of the flap may be associated with a risk of donor site morbidity—most importantly shoulder dysfunction. Muscle sparring alternatives, including the muscle sparring LD (MS-LD) flap and the thoracodorsal artery perforator (TDAP) flap, has been introduced based on the hypothesis that these would reduce post-operative sequelae. Methods: We conducted a review presenting the available literature on donor site morbidity after TDA flap harvest with focus on shoulder dysfunction. We found 12 papers dealing with shoulder dysfunction after breast reconstruction with the TDA flaps. Level of evidence (LOE) are highest for LD flaps and lower for the muscle sparring versions. Conclusions: The available evidence on shoulder morbidity after breast reconstruction with the TDA flaps is scarce and has a low LOE. Furthermore, outcome measures and follow-up time are not uniform and most of the publish studies either lack a control group or simply do not compare the relevant outcomes between groups. However, there is a clear trend showing low functional impairment after reconstruction with the muscle sparring flap types.