What is a TAP Flap?
When there is a need for breast reconstruction on just one breast or a smaller amount of tissue, our board-certified plastic and reconstructive surgeon, Dr. Aldona J. Spiegel, may recommend a thoracodorsal artery perforator flap, or TAP flap. The area from one the side of the breast to the back is an ideal place to harvest tissue for smaller defects or additional tissue without sacrificing any muscle. This also means that the TAP area is usually not an ideal donor site for full breast reconstruction — there just is not enough tissue. The great news about the TAP flap is that it is a muscle-sparing technique. You will not lose strength in your lat muscles, which impacts your arm strength. Find out more at a consultation with Dr. Spiegel in Houston, TX.
"I cannot recommend Dr Spiegel and her team more highly. I attended her clinic when having trouble with uncomfortable implants after a previous mastectomy. Dr Spiegel suggested DIEP procedure and I was really not sure. Over the coming months both she and her team explained the procedure, the benefits and results and implications. I decided to go ahead and I could not be more happy with the results. I look like I would have done pre mastectomy. I have been amazed by the continued care and concern of the whole team from the finance folk to the clinic nurses and doctors and their absolute pleasure in seeing my delight. A fantastic experience and I can't thank them enough."- C.A. / Google / Aug 01, 2019
"Dr. Spiegel and her wonderful staff got me through the most difficult experience of my life. Going through mastectomy and DIEP flap reconstruction is traumatic. I chose her over other Houston area surgeons and felt that I could trust her. Everyone in her office supported me each step of the way. First, and foremost, this is a major surgery and you rely on medical excellence to avoid important risks. She is a perfectionist regarding medical safety. Next, her artistry is outstanding. She got the best result that could be possible. Finally, if you have radiation, it is a long journey of several years to get from the beginning to end of the process, involving a year of a temporary expander before the final reconstruction. It is important to have a team that you can have that trusting supportive relationship over time. I feel very lucky and grateful that I was in the hands of this wonderful group of highly skilled women."- L.S. / Google / Jul 08, 2019
"Dr. Spiegel was highly recommended by my oncologist. It had become necessary that I look into reconstruction and a lymph node transplant. Dr. Spiegel does amazing work. She loves what she does and it shows in the results that she achieves. I am very happy that I chose her for this journey! Her support staff are wonderful to work with as well!"- D.M. / Google / Jul 08, 2019
"Dr. Spiegel is my guardian angel and I owe her and her entire team and staff a debt of gratitude that I will ever be able to repay! I am one year out from my original Diep flap surgery with her and I feel great- like myself again! After undergoing a prophylactic mastectomy ( due to testing positive for the BRCA 2 gene and strong family cancer) and getting breast implants with another doctor, Dr. Spiegel saved my life by removing the implants and performing Deip surgery. The implants cased me so much pain and diminished my quality of life but now I have it back. I have no more pain and my breasts are soft again and created from my very own tissue. Thank you Dr. Spiegel!"- J.A. / Google / Jul 08, 2019
"Dr. Spiegel is simply fantastic. I am so grateful to her and her whole staff (Alexis/Nicole/Lisa/Aidee/Angie) for the wonderful care and support given to me from my very first visit to their office. Dr. Spiegel is so thorough that during the course of my visits, she insisted that I consult a GI doctor for my distended stomach. Turns out that I had an H Pylori infection for which I had to be treated. No other doctors had ever looked past their specialties to treat the whole individual, and I am 59 years old. Subsequently, Dr. Spiegel pushed for an endoscopy, and it was discovered that I had an ulcer for which I was treated. From cardio work up, lab tests to chest xrays, Dr. Spiegel ensured that I was in top shape for surgery and made sure that I understood all aspects of the procedure and treatment.During my stay at the hospital, Dr. Spiegel, Alexis, Nicole, Dr. Arroyo, and Dr. Vo infused me with so much strength, support and kindness that I have no words to express my gratitude and appreciation. It's been one month since my surgery and I'm feeling good, healing very well and going back to work next week. Awesome doctor and wonderful staff."- R.L. / Google / Jun 08, 2019
TAP Flap Candidates
At Aldona J. Spiegel, M.D., she performs the TAP flap for women who:
- Have only one breast that needs reconstruction (like a lumpectomy patient)
- Need more tissue harvested to fill out and supplement an area of need in breast reconstruction
- Desire to augment their breast with their own tissue and a small breast implant
Many women feel that having a TAP flap reconstruction is worth the lengthy surgery to get the aesthetic benefits for their breasts but also to keep their lat muscles strong.
How is a TAP FLAP performed?
You will be admitted to a local hospital, like Houston Methodist Hospital, where Dr. Spiegel has medical privileges. The TAP flap procedure will be performed in an operating room with general anesthesia. The incision in the back will be right at the bra line so that it can be easily hidden with clothing on. Only skin and fat will be removed on the side of the breast and the back. The harvested donor tissue will be rotated from the upper back to the chest with the blood vessels attached to the thoracodorsal artery. Dr. Spiegel will split the blood vessels between both areas so that each can have their own blood supply. She will reshape the tissues and create your breast. Incisions will be closed with absorbable sutures and drains in both areas. You will also have a Doppler wire placed to help with the monitoring of the blood flow in your flaps. Expect to wake up in the recovery room and be cared for by our diligent post-op nursing staff in a patient room. We will continue to care for you around the clock until you are discharged.
Monitoring the TAP Flap
Even though your flap may consist of less tissue than other flap reconstructions, you will need to follow the same protocol for monitoring your breast. If not, you may compromise the flap and it will have to be removed. You will leave the hospital with a Doppler wire in a waterproof bandage, absorbable sutures, and drains to manage until Dr. Spiegel recommends their removal. In the early days of your breast flap recovery, keeping a close watch on the health of each flap will be necessary. There is a chance that the flap may fail, but you can do your part by looking for discoloration, fever, infection, and more to help that not happen.
In TAP FLap Recovery
You can expect several scheduled follow-up appointments to make sure your surgery is a success. We will document your progress and address any problems you may have along the way.
Here are a few more tips:
You will need a compression garment
For your convenience, you can order a fitted compression bra at our practice for $30.00 per bra. You can send your insurance provider the receipt we give you for a reimbursement claim. We want you to wear this type of bra to limit swelling and discomfort.
Taking time off for TAP flap reconstruction recovery
We recommend that you take at least four weeks off for your surgery. If you perform heavy lifting in your job, then you may need more time to be able to do your job. You will also need to pace yourself as you recover to not overextend yourself or hurt yourself in the process.
It is necessary to limit your activities for a while
Driving will not be allowed until Dr. Spiegel releases you to get behind the wheel. We also strongly recommend that you stop smoking or being in the same room with cigarette smoke for at least six weeks post-op. Moving your body will not be easy for a while, and we hope you will take care of yourself during this transition. It is normal to get easily fatigued, and your movement should be minimal at first. Lifting your arms above your shoulders should be avoided for the first week or longer after surgery. Pace yourself when moving around the house to do household chores. We have a set weight restriction. You should not lift anything more than five pounds for the first month. As you get stronger and with Dr. Spiegel's blessing, you can return to your gym for light exercise, but wait at least two months after surgery to do your normal routine. Upper body strength will be less, and it may be months before you can use the compensating muscles in your shoulder to build up more strength.
You will need a recliner
Your body may only be comfortable in one position for a while. A recliner is a nice place to sleep as you recover from your surgery. You will not want to sleep on your stomach right now anyway. You can even elevate your knees with two pillows. Sleep in a recliner (even if you have to rent one) for 3 – 4 weeks after your surgeries.
Check your breasts
Even though you do not have breast tissue, it is always better to be safe when it comes to your health. You will still need to have regular breast exams at home and with your physician. Mammograms may be ordered by your oncologist or primary doctor.
Your Support Community
For your physical and mental benefit, Dr. Spiegel has a network of women called "The Pink Sisters" who will be additional support in your treatment. These women are breast cancer survivors who have gone through the same medical situation as you. In this group, you will be provided with information that is uplifting to help you cope and be strong through this process. Your emotional well-being matters to us, too. We can also match you up with a former patient that has had the same procedures as you will have with Dr. Spiegel.
Let's Talk about TAP flaps
If you would like to set up a meeting with Dr. Aldona J. Spiegel to talk about your need for reconstructive surgery, please reach out to us online or at our Houston, TX practice. TAP flap breast reconstruction can also be paired with a neurotization surgery to regrow nerve fibers. Dr. Spiegel will have your best interest at heart as your surgeon. Meet with her privately in a consultation at her practice within the campus of Houston Methodist Hospital.