A TDAP flap borrows skin and fat from the side of the back, raised on a single vessel that passes through the broad back muscle. Because that muscle stays in place, shoulder power is largely preserved.
A TDAP flap takes skin and fat from the side of the back on a vessel that pierces the broad back muscle. Surgeons free that vessel through the muscle fibres, so the muscle itself is left working. Tissue can then be swung to the chest or armpit, or moved further and joined under a microscope.
The broad muscle across the side of the back receives its blood from a single large vessel that also sends branches upward into the overlying skin. Traditional surgery moved the entire muscle with that skin, which reliably filled defects but cost the patient shoulder power. In a TDAP flap the surgeon follows one branch through the muscle fibres and lifts the skin alone.
That change matters most for people who push, pull or climb for a living, and for anyone already relying on their arms for mobility. Shoulder strength is not entirely unaffected, since dissection disturbs the muscle, but function is generally far better preserved than after removal of the whole muscle.
Because the vessel is long and mobile, this flap can be swung to the chest wall, armpit or upper arm without any microsurgery, which makes it a workhorse for partial breast reconstruction and for releasing a tight armpit after burns. When a distant site needs cover, the same tissue can be transferred as a free flap instead.
It suits chest, breast and armpit reconstruction where nearby living tissue is needed and shoulder strength should be protected.
The perforating vessel is located with a doppler probe while you are awake or asleep, and the flap is marked so the scar can sit along a bra line or natural skin crease.
Scar, tumour bed or damaged tissue is cleared and measured, and the route the flap will travel to reach it is planned before any dissection begins.
The skin paddle is lifted and the chosen vessel is traced down through the muscle fibres. Muscle is split rather than removed, then repaired once the vessel is free.
For nearby defects the flap is passed under a skin tunnel to the chest or armpit. For distant sites the vessels are divided and rejoined under a microscope.
Tissue is shaped into the defect, drains are placed at the back and both wounds are closed. Position of the arm is checked before dressings go on.
The flap is monitored regularly and the arm is rested in a supported position. Drains stay at the back, and lying directly on the donor side is avoided.
Drains often remain longer here than at other donor sites because of fluid build up. Gentle shoulder exercises begin under guidance, avoiding forceful pulling.
Shoulder movement usually approaches its earlier range with therapy. The back scar is firm and pink, and swelling in the flap continues to settle.
Strength for pushing and pulling builds back with graded exercise. Scars soften, and any residual fluid pocket at the back is reviewed and treated if it persists.
Contour and cover generally improve, and a released armpit often allows the arm to lift much further. The transferred skin differs in colour and thickness from the chest, and it may look bulky before swelling settles. Shoulder strength usually recovers well, though some people notice a difference with heavy pulling. A back scar remains, and fluid collections there can take several visits to settle.
Most difficulties with this flap concern the back wound rather than the flap itself, and they are worth knowing about early.
Looking after the back wound and keeping the shoulder moving are the two tasks that shape recovery at home.
Taking the whole muscle does affect strength. This technique spares the muscle, so most people keep good function with therapy.
Fluid can still gather after drains are removed. Reviews continue for that reason, and a simple clinic drainage may be needed.
Planning usually places it along a bra line or a natural crease, though its position depends on where the vessel sits.
It supplies moderate volume. Rebuilding an entire breast from your own tissue more often calls for abdominal tissue instead.
Elegance Clinic in Surat plans back flaps with the scar position and the shoulder in mind, because both affect daily life long after the wound heals. Options are compared openly before any date is agreed.
Because this page describes a technique, it carries no price of its own. Cost depends on the treatment the TDAP flap serves, on whether it is swung locally or transferred with microsurgery, and on theatre time, hospital stay and physiotherapy.
You receive a written estimate after assessment, and the related treatment page lists the usual band.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →The treatment sets the price, not the technique. A flap swung locally uses less theatre time than one transferred with microsurgery. Hospital stay, drains, garments and physiotherapy also count, and a written estimate follows assessment.
It is an established technique with the usual surgical risks of bleeding, infection and clots. Specific concerns are fluid collecting at the back and, in free transfers, the joined vessels blocking. Both are managed by close follow up.
Longer than for many other flaps, because this donor site tends to produce fluid. Drains come out when output settles rather than on a fixed day, and further drainage in clinic is sometimes needed.
Usually far less than after removal of the whole muscle. Some people notice a difference with heavy pulling or overhead work. Regular exercises through the first months make a real difference to what returns.
It provides moderate volume and suits partial defects, thin cover over an implant or a tight armpit. Rebuilding a complete breast from your own tissue usually calls for abdominal tissue instead.
It depends on the underlying problem. After cancer surgery, timing is agreed with the oncology team around radiotherapy. For burn contractures, release is planned once scars have matured and therapy has reached its limit.
The defect, the back and shoulder movement are examined, and the vessel is located with a probe. Scar position is marked with you, and risks, alternatives, recovery limits and the written estimate are explained before booking.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
