Lateral Intercostal Artery Perforator Research Articles

A revised modified LICAP flap as a novel oncoplastic breast-conserving surgery technique for Mammary Paget’s disease

Mammary Paget’s disease is a rare form of breast cancer that presents a unique challenge to surgeons for patients who opt for breast-conserving surgery. Due to oncoplastic techniques, the options for breast-conserving surgery have diversified and allow for improved cosmetic outcomes. We present a 68-year-old lady with Mammary Paget’s disease who underwent a modified lateral intercostal artery perforator flap with a skin paddle to reconstruct the new areolar region. With this technique, we achieved complete oncological resection with excellent cosmetic outcome.

Evaluation of the Efficacy and Safety of Pedicled Perforator Flap Technique for Salvage Nipple Reconstruction in Breast Cancer Patients: A Pilot Study.

We propose a pedicled perforator flap technique for salvage nipple reconstruction after initial nipple reconstruction fails in breast cancer patients. This is a pilot study. A total of 21 female breast cancer patients who underwent nipple reconstruction following initial nipple reconstruction fails were enrolled, and salvage nipple reconstruction based pedicled perforator flap were performed between 2016 and 2020. Operative time, perforator design, postoperative complications, follow-up duration, projection of nipple, as well as patient-reported outcomes measured by the BREAST-Q and visual analogue scale (VAS) were assessed. Sixteen patients underwent fifth lateral intercostal artery perforator reconstruction, while 5 patients underwent fifth anterior intercostal artery perforator flap reconstruction. The surgeries were successful without intraoperative complications, with a mean operative time of 67 minutes. Postoperative complications were absent. The mean follow-up duration was 18 months. The mean nipple projection was 8mm (range, 6-10mm) with a shrinkage of 20% at 6 months after surgery. The average scores for psychosocial well-being, satisfaction with breasts, and satisfaction with nipples domains of the BREAST-Q significantly increased (P < .01) at 6 months post-reconstruction. Sexual well-being subdomain showed no statistical difference (P = .9369). The VAS scores for cosmesis and patient satisfaction with surgery were 9 and 9.3, respectively. The pedicled perforator flap technique for salvage nipple reconstruction is a safe and effective approach.

Chest wall perforator flap partial breast reconstruction: a retrospective analysis of surgical, cosmetic and survival outcome.

Oncoplastic breast surgery includes volume replacement as well as volume displacement. Autologous tissue is the preferred approach for volume replacement and includes chest wall perforator flaps (CWPF). Although described more than a decade ago, CWPFs have not been adopted widely in clinical practice till recently. We report the largest single-centre institutional data on CWPFs. The study includes all patients who underwent breast conservation surgery (BCS) using CWPFs from January 2015 to December 2022. Data were retrieved from the institutional electronic record and Redcap database. The analysis was done using SPSS 23 and STATA 14. 150 patients were included in the study. The mean age was 48.8 years (SD 10.4), and the body mass index was (26.6 kg/m2, SD 4.3). >50% of patients had breasts with small cup sizes (A&B) and mild ptosis (Non-ptotic and Grade 1 ptosis). 44.7% of patients underwent lateral intercostal artery perforator flap (LICAP), anterior intercostal artery perforator flap in 31.3%, lateral thoracic perforator flap (LTAP) in 12%, LICAP + LTAP in 11.3% and thoracodorsal artery perforator flap in 1%. Post-operatively, haematoma was seen in 1.3%, complete flap necrosis in 1.3%, seroma in 7%, wound dehiscence in 12%, and positive margin in 6.7%. 92 patients responded to the satisfaction assessment, of which >90% were happy with the surgical scars, comfortable going out in a public place, satisfied with the symmetry of the breast, and no one chose mastectomy in hindsight. The 5-year predicted disease free survival and overall survival were 86.4% and 94.7%, respectively. BCS with CWPF is an excellent option for reconstruction in small to medium-sized breasts. It is associated with minimal morbidity and comparable patient-reported cosmetic and survival outcomes.

Feasibility and early cosmetic outcome of modified lateral intercostal artery perforator flap after breast conservative surgery

BackgroundThe lateral intercostal artery perforator (LICAP) flap aims at replacing the excised breast lump with axillary tissue rich blood supply. The purpose of this study is to report the initial results of a modification LICAP flap technique in terms of intraoperative technical feasibility and short-term cosmetic outcomes in the early postoperative period.MethodsModified LICAP flap technique was performed on 36 female patients with pathologically proven BC located in the outer half of the breast in the period from June 1, 2021, to April 30, 2022.ResultsThe LICAP flap modification enabled performing the procedure with the patient in supine position without repositioning. The majority of the patients (90%) had satisfactory early cosmetic results as reported by the patients and oncoplastic independent surgeon.ConclusionModified LICAP flap reconstruction is feasible to be performed with the patient in supine position without repositioning and it has satisfactory early cosmetic outcomes.

The Utility of a Novel Bidirectional Lateral Intercostal Artery Perforator Flap for Reconstructing Partial Mastectomy Defects.

Smaller breasts require volume replacement to allow for breast conservation for large tumor to breast size ratios. The lateral intercostal artery perforator (LICAP) flap is one of the most commonly used approaches to replace volume as it readily fills lateral breast defects where most cancers typically arise. The LICAP flap was initially described with the bulk of its tissue volume oriented posteriorly, lateral to the breast footprint. Recently, the "reverse LICAP" flap was described, which uses the same perforators but recruits tissue instead from below the inframammary fold. Here, we combine these two approaches, preserving the same perforators, but harvesting tissue from both below the inframammary fold and lateral to the breast footprint, to create a single, larger, bidirectional LICAP flap. This modified flap replaces more volume than previously described for uni-directional approaches allowing us to potentially avoid mastectomy or more extensive flap reconstructions. Here, we describe 10 consecutive patients where the bidirectional LICAP flap was used to facilitate oncoplastic breast conservation.

A before and after evaluation of patient reported outcomes assessed by Breast Q following LICAP turnover flap in breast conservative therapy.

Chest-wall perforator-based techniques to replace volume for breast conservative therapy allow excision of large breast areas with minimal sequalae, such as the nipple-areolar complex displacement, parenchymal indentation or contour deformity. Furthermore, chest wall perforator flaps facilitate the maintenance of breast symmetry, hence decreasing the need for contralateral surgery. Lateral intercostal flap was described in numerous variants among which the most famous are the propeller flap and the turnover version. The turnover version is the easiest and fastest version that allows the replacement of large amount of volume. In this paper, we evaluate patients reported outcomes, before and after surgery, collected through the Breast Q. This study was conducted on 21 patients who were admitted to the plastic surgery department. A prospectively maintained database was used to identify the patients and their records were assessed retrospectively. The pre/post operative patients data were collected. The Breast-Q questionnaire was administered before the surgery and at least 1year after. No major surgical complications were reported. Mean Breast-Q scores were evaluated at least 1year after surgery and radiotherapy and compared with pre-surgical scores. Among all the modules, no significant differences between the pre-surgical and post-surgical Breast-Q scores were observed. Until now, the lateral intercostal artery perforator flap has not been widely used, due to a difficult dissection and a challenging preoperative planning. According to the reported surgical technique, the execution is easy. This technique provides the same breast-related quality of life compared to preoperative values, reduces the mastectomy rate and increases the overall survival.

Chest wall perforator flaps for partial breast reconstruction after conservative surgery: Prospective analysis of safety and reliability

IntroductionBreast-conserving surgery associated with adjuvant radiotherapy is the state of the art in the surgical treatment of breast cancer. Oncoplastic surgery through dermo-adipose flaps based in perforating arteries (muscle sparing flaps) for partial reconstruction is increasingly used as a good option for avoiding musculocutaneous flaps. In this study we evaluate the outcomes of the use of chest wall perforator flaps in the replacement of partial breast volume. MethodsA prospective cohort study of female patients that underwent a conservative oncoplastic surgery procedure with partial breast reconstruction using a dermo-adipose flap of perforating arteries of the chest wall was conducted between November 2020 and March 2022 at our centre. Primary outcomes were surgical morbidity, positive margins and reoperation rates. Characteristics associated with the occurrence of complications were further identified. ResultsForty-five patients underwent the procedure of interest during the study period. The mean age was 55 years. The median larger dimension of the tumor was 23 mm. Lateral intercostal artery perforator (LICAP), lateral thoracic artery perforator (LTAP), a combined flap and Anterior Intercostal Artery Perforator/Medial Intercostal Artery Perforator (AICAP)/(MICAP) were performed in 22, 16, 2 and 5 patients, respectively. The mean operative time was 126 min. A total of 9 (20.0%) patients required a reoperation after definitive diagnosis, 4 due to positive margins and 5 due to immediate/early surgical morbidity. ConclusionsLocal perforator flaps in oncoplastic breast-conserving surgery are a good option for immediate reconstruction after conservative surgery, showing low morbidity and favourable outcomes.

No Doppler Single Position-Lateral Intercostal Artery Perforator Flap (NDSP-LICAP):a Safe and Versatile Flap for Breast Oncoplasty in Resource-Limited Setting.

The lateral intercostal artery perforator flap (LICAP) has emerged as one of the safest and less morbid flaps for lateral and central breast defects. We hereby describe a reproducible no Doppler single position (NDSP) technique to harvest it in single position without handheld Doppler, making it a versatile flap for lateral breast defects in resource-limited setting also. With this technique, we performed a total of 22 LICAP turnover flaps over a period of 18months from January 2020 to June 2021. In all 22 cases, the indication of flap was to fill the post-breast conservation surgery (BCS) defects in outer quadrant of breast. All LICAP flaps were harvested by surface marking of anatomical landmarks and without handheld Doppler. Out of 22 LICAP turnover flaps, thirteen were harvested for left breast and nine for right breast. The median width and length of the flap were 12.2cm and 19.6cm, respectively. The additional mean operative time was 41min. All LICAP flaps survived well, and grade 1 Clavien-Dindo morbidity was documented in four cases. Mean hospital stay was 2.6days. All patients received radiotherapy on their stipulated schedule. Early cosmetic outcome was good, and long-term outcomes are awaited. NDSP-LICAP flap is a workhorse for lateral breast defects. Precise knowledge of perforators and anatomical landmarks can be used for harvesting these flaps, thus avoiding ultrasound Doppler and dedicated training for perforator localization. This technique has short learning curve without the need for any plastic surgery training. The early cosmetic outcomes are good.

Intercostal artery perforator flaps for partial breast reconstruction after breast-conserving surgery

Introduction Breast conservative surgery’s objectives include a thorough oncologic excision and a satisfactory aesthetic outcome. The greatest strategy to prevent undesirable aesthetic outcomes is to use oncoplastic procedures to do so during conservative surgery in one step. For small to medium-sized breasts (up to C or D cup size), volume replacement treatments are advised, particularly in cases of bigger tumors. This entails inserting tissue into the tumor excision defect from a nearby or distant site. Musculocutaneous flaps, fasciocutaneous flaps, and most recently ‘perforator’ skin flaps have all been used in autologous tissue restoration. Due to the intercostal artery’s strong blood supply, anterior and lateral intercostal artery perforator (LICAP) flaps are dependable tissue sources. These flaps have the benefit of being able to fill the resection cavity, preventing further deformities. The study aimed to assess the feasibility of intercostal artery perforator flaps in partial breast reconstruction following breast-conserving surgery. Materials and methods The study was carried out on 42 breast cancer patients admitted to the surgical oncology unit, at Alexandria Main University Hospital in the duration between January 2021 and December 2022. A modified lateral intercostal artery perforator flap (mLICAP) and anterior intercostal artery perforator flap (AICAP) were used depending on the tumor location within the breast. The postoperative assessment was done by another breast surgeon and by the patient. Results Modified LICAP was used in 37 patients and AICAP was used in 5 patients. 90.5% of patients were satisfied with the aesthetic outcomes (85.7 gave excellent results). 69% of patients had excellent results based on the surgeon’s assessment. Complications were encountered in 11 patients in the form of seroma, hematoma, and minimal wound dehiscence. Conclusion Modified LICAP affords excellent access to the axilla and offers an option that facilitates both a pleasing aesthetic result and obviates the need for symmetrizing contralateral surgery to maintain breast symmetry. AICAP is a good option to partially reconstruct the breast following BCS for tumors located in the lower half of the breast.

P239 Multi-institutional Experience of Modified Lateral Intercostal Artery Perforator (LICAP) Flap Operation: Surgical and Patient Reported Outcomes (PROMs)

P239 Multi-institutional Experience of Modified Lateral Intercostal Artery Perforator (LICAP) Flap Operation: Surgical and Patient Reported Outcomes (PROMs)

Oncoplastic breast volume replacement with the use of lateral intercostal artery perforator flap

Breast cancer is very common, and there has been a lot of progress in terms of diagnosing and treating it. Surgical intervention, which is tailored to the patient's particular needs and numerous clinical concerns, is one of the management methods used. Some indicators that can be used are, for instance, the size and the stage. Smaller and earlier stage malignancies can be treated with a wide excision. However, getting a proper excision margin around the tumor and not removing too much tissue is problematic. Several studies have shown that when 20% of the breast volume is removed, there is a significant risk of deformity. Currently, oncoplastic surgery is the gold standard for breast reconstruction to minimize such a risk, and one of the techniques is volume replacement, which includes reconstruction of the breast with the transposition of tissue from elsewhere. Numerous volume replacement procedures were performed in the reported patients. The thoracodorsal artery perforator (TDAP) and lateral intercostal artery perforator (LICAP) flaps showed good outcomes in terms of cosmetic and oncological aspects, yet LICAP was found to be an excellent choice for the lateral breast defect and the aesthetic result was satisfactory. We present the case of a 19-year-old woman who had a borderline phyllodes tumor and 49-year-old woman with invasive breast cancer ductal carcinoma in situ (DCIS) that was treated with a wide excision and volume replacement with a LICAP. Following the success of the LICAP treatment, the defect appears symmetrical with the contralateral breast a few weeks following surgery. In conclusion, LICAP and TDAP flaps oncoplastic surgery offer advantages that should be considered to increase satisfactory of the patients after breast construction surgery in Indonesia.

Case report of stacked intercostal artery perforator flaps: a novel technique using anterior and lateral intercostal artery perforator flaps for full autologous breast reconstruction post-mastectomy

: Surgery is the mainstay of curative treatment for breast cancer with mastectomy offering the lowest risk of local recurrence. Post-mastectomy reconstruction options include autologous flaps and/or implants. Autologous flaps are commonly harvested from various areas, including rectus abdominis muscle, latissimus dorsi muscle, gracilis muscle and gluteal areas. While good cosmetic outcomes are often achieved, donor site morbidity and long patient downtime remain an issue. The intercostal perforator flaps have fewer of these problems but it often does not have sufficient volume for full reconstruction after mastectomy. Intercostal perforator flaps were developed for volume replacement after breast-conserving surgery. These perforator flaps are not used for full autologous reconstruction after mastectomy as the volume from a single perforator flap is often inadequate. Hence, the authors describe the first report of a novel approach of combining the anterior intercostal artery perforator (AICAP) flap and lateral intercostal artery perforator (LICAP) flap, the stacked intercostal artery perforator (STICAP) flaps, for full autologous reconstruction following an areolar-sparing mastectomy. Our patient is a 76-year-old lady diagnosed with a left breast 6 o’clock retro-areolar invasive ductal carcinoma measuring 2.8 cm × 1.6 cm × 2.3 cm. The patient underwent a left breast areolar-sparing mastectomy and axillary sampling followed by immediate STICAP (AICAP and LICAP) flaps reconstruction which achieved an excellent aesthetic appearance and high level of patient satisfaction.

Partial breast reconstruction of 30 cases with peri-mammary artery perforator flaps

BackgroundVolume replacement is one of the vital techniques of oncoplastic surgery (OPS) when applying breast-conserving surgery. The clinical application of peri-mammary artery perforator flaps for this indication is uneven in China. Here, we describe the results of our clinical experience with peri-mammary artery flaps for partial breast reconstruction.MethodsIn this study, 30 patients underwent partial breast resection for quadrant breast cancer followed by partial breast reconstruction with peri-mammary artery perforator flaps, which included the thoracodorsal artery perforator flap (TDAP), anterior intercostal artery perforator flap (AICAP), lateral intercostal artery perforator flap (LICAP), and lateral thoracic artery perforator flap (LTAP). All the patients’ operation plans were discussed comprehensively and were performed by sticking to every step. The satisfaction outcome was assessed with the extracted version of the BREAST-Q version 2.0, Breast Conserving Therapy Module Preoperative and Postoperative Scales both preoperatively and postoperatively.ResultsAccording to the study outcomes, the mean flap size was 5.3*4.2*2.8 cm (3.0–7.0*3.0–5.0*1.0–3.5 cm). The mean surgical time was 142 min (100–250 min). No partial flap failure was detected, and no severe complications were observed. Most patients were satisfied with the outcomes regarding the dressing, sexual life, and breast shape postoperation. Furthermore, the sensation of the surgical area, scar satisfaction, and recovery state gradually improved. Overall, LICAP and AICAP had higher scores when different flaps were compared.ConclusionsBased on this study, we found that peri-mammary artery flaps had significant value in breast-conserving surgery, especially in patients with small or medium-sized breasts. Perforators could be detected by vascular ultrasound before the operation. More than one perforator could be found most of the time. No severe complications occurred when performing a suitable plan, including discussing and recording the operation procedure; the focus of care, the choice for precise and proper perforators, and the mechanism for hiding the scars were all considered and recorded in a specific chart. Patients were satisfied with the reconstruction technique of peri-mammary artery perforator flaps after breast-conserving, and the satisfaction of AICAP and LICAP was higher. In general, this technique is suitable for partial breast reconstruction and has no negative impact on patient satisfaction.

Surgical Outcomes Following Partial Breast Reconstruction with Chest Wall Perforator Flaps

Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1st January 2018 to 30th June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m2. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.

Modified Lateral Intercostal Artery Perforator Flap in Immediate Partial Breast Reconstruction for Breast Cancer: A Retrospective Cohort Study

Introduction: The primary surgical options for treating breast cancer involve mastectomy or Breast Conservative Surgery (BCS), which may or may not include reconstruction procedures. BCS helps achieve complete tumour excision with an acceptable cosmetic result. Contour deformities and asymmetry are associated with tissue excision in the lateral aspect of the breast. To address this issue, various techniques of volume replacement, such as the modified Lateral Intercostal Artery Perforator (LICAP) flap, can be performed. Aim: To demonstrate the outcomes of a modified LICAP flap when a muscle flap is not available or desired. Materials and Methods: A retrospective cohort study was conducted, reviewing all modified LICAP flaps performed for breast tumours in Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, a tertiary-level cancer centre, from June 2018 to August 2020. Patient demographics, surgical details, histopathology reports, and postoperative complications were collected. Results: Ten patients underwent modified LICAP flaps over a two-year period. All patients had pT2 tumours with marginnegative resection, and the mean resection volume of the specimen was 370 cm3 . Intraoperative patient repositioning was not necessary during the modified LICAP flap procedure. One patient experienced marginal wound necrosis, which was managed conservatively. No patients had scars extending beyond the posterior axillary line, and axillary dissection was performed without a separate incision. Conclusion: The present study demonstrates the advantages of using a modified LICAP flap for breast reconstruction. The modified LICAP flap can be considered as an option for tumours located in the outer aspect of the breast, providing good access to the breast as well as the axilla, with an aesthetically acceptable scar.

Modified chest wall lateral intercostal artery perforator (MCW‐LICAP) flap: a versatile flap in the era of oncoplastic breast surgery

Breast reconstruction following oncological resection is becoming more common in recent years. In some ladies, implant reconstruction is not ideal due to significant implant visibility or palpability. Autologous reconstruction addresses the limitations of implant reconstruction but results in potential donor site morbidities. To date, there is no clear advantage ascribed to any technique. With appropriate selection, patients with adequate lateral mammary fold have the option of reconstruction with MCW-LICAP flap. We present our techniques and outcomes from a series of 29 patients who underwent MCW-LICAP flap. A retrospective review of consecutive patients who underwent curative resection for breast cancer with immediate MCW-LICAP flap reconstruction, between July 2018 to April 2022 was conducted. The techniques used with its variations along with video demonstrations are presented. A total of 29 patients underwent 34 procedures. Nineteen breast conserving surgeries and 15 mastectomies were completed, and immediate reconstruction performed in all cases. Twenty-three patients had MCW-LICAP, 1 with a Stacked intercostal artery perforator (STICAP) flap, and 5 had MCW-LICAP combined with a Goldilocks mastectomy. There were no cases of complications requiring re-operation. All patients had acceptable time to adjuvant therapy with a median of 36 days. Learning curve analysis showed a significant reduction in operative time after the 6th case. In our preliminary experience, MCW-LICAP flap is a safe, reliable, and versatile oncoplastic reconstruction option.

The Ultrasound Evolution of Lateral Thoracic Perforator Flaps Design and Harvest for Partial and Total Breast Reconstruction.

The lateral thoracic area is a known source for perforator flaps for partial breast reconstruction. In this paper, we report our experience in designing and harvesting lateral thoracic perforator flaps for partial and total breast reconstruction with the introduction of the "propuller" concept. Between September 2013 and August 2021, 95 flaps were performed for immediate, partial and total breast reconstruction. On a total of 95 flaps, 30 (19 thoracodorsal artery perforator(TDAP) flaps, 10 lateral intercostal artery perforator(LICAP) flaps and 1 lateral thoracic artery perforator(LTAP) flap) were harvested in the traditional fashion (control group) and 65 (57 LICAP, 2 LTAP and 6 TDAP flaps) according to the propeller concept (study group). All cases were preoperatively planned with Color-Coded Duplex Ultrasound. No flap losses were experienced in both groups. The mean operative time was 156 minutes (range 118-234) for the control group and 75 minutes (range 53-125) for the study group (p<0.0001). A significantly higher number of LICAP flaps were chosen in the study group compared to control group. None of the patients had donor site complications. Patients' and Surgeons' satisfaction was high to very high. The ultrasound preoperative planning led to the development of an easier and safer method of local perforator flap harvesting, that we named as propuller design. Its novelty lies in that perforator intraoperative selection and fully skeletonization are not needed and a more efficient flap movement (propeller plus advancement) which transfers more tissue into the new breast can be achieved safely, faster and easier.

Lateral Intercostal Artery Perforator Flap for Breast Cancer: A Case Report from Oman

Breast cancer is the commonest cancer in females. Historically, breast cancer surgery (BCS) was not considered a safe option, until 20 years back when those concerns were dismissed by the introduction of several surgical techniques. Today, women living in countries with fairly advanced healthcare systems, have the option of getting surgical treatment that is both safe and aesthetically pleasing. One of the promising surgeries being discussed in literature and is not widely practiced worldwide is the Lateral Intercostal Artery Perforator Flap (LICAP) flap. We present a case of a 52 y/o lady who self-presented to the Breast Surgery Outpatient Department (OPD) after she noticed a mass on her left breast. The patient was willing for BCS as she was particularly concerned about cosmesis. LICAP flap surgery was performed and the results were remarkable. LICAP flap is a surgical technique that, despite it requiring sharp surgical skills, continues to be a promising addition to the BCS options for women with breast cancer. With good planning and using intra-op ultrasound it can be the preferred choice for many patients.

Intercostal Artery Perforator Flap for Salvage Breast Reconstruction with Exposed Breast Implants.

Background:Multiple techniques have been described for breast reconstruction surgery after breast implant exposure; breast implant removal and delayed breast reconstruction is the procedure of choice. However, in some mild exposures and infections, we propose an alternative treatment.Methods:This is a case series of a 14-year study in 16 female patients with mild exposure of a breast implant after breast reconstruction surgery. Salvage surgery was performed on these cases. The defects were between 1 and 6 cm, with a median size of 3.9 × 2.9 cm. Eighteen intercostal artery perforator flaps were used with an island of skin from the inframammary fold; 83.3% were anterior intercostal artery perforator flaps‚ and 16.7% were lateral intercostal artery perforator flaps.Results:Thirteen of the 16 patients presented infection (81.25%). There was no necrosis of any flap, and the success rate of salvage surgery was 62.5% of all patients. The success of surgery was 53.8% in patients with breast infection and 100% in patients without infection. Seven patients received chemotherapy and radiotherapy, six received only chemotherapy, and nine patients received only radiotherapy. Five of the six patients whose salvage surgery failed were treated with radiotherapy.Conclusion:This technique can be used as an alternative when there is exposure of the implant‚ even in cases with a mild breast infection and in patients undergoing radiotherapy and chemotherapy.

LICAP Versus TDAP for the Reconstruction of Partial Breast Defects.

Perforator flaps are the latest development in reconstructive surgery. Pedicled chest wall perforator flaps can be utilized in many cases of partial breast reconstruction. This research compares the outcome and technique of thoracodorsal artery perforator flap (TDAP) and the lateral intercostal artery perforator flap (LICAP) in the reconstruction of partial breast defects. Patient records were reviewed for the time period between 2011 and 2019 at the Breast Unit of the National Cancer Institute of Cairo University. Eighty three patients were accessible for the study. (46 cases of TDAP flap and 37 cases of LICAP flap). Relevant clinical data were extracted from patients' records. A special visit was organized for all 83 patients, where a digital photograph was taken in an antroposterior view. The photographs were later processed via BCCT.core software to obtain an objective cosmetic outcome assessment. Complication rates and cosmetic outcome were comparable for both techniques. TDAP flap proved to require more tedious dissection and preoperative Doppler mapping to localize perforator vessels. On the other hand, LICAP was technically easier with more consistent perforators. Pedicled chest wall perforator flaps constitute an excellent reconstructive option in partial breast defects. TDAP flap and LICAP are two reliable perforator flaps which can reconstruct outer breast defects with acceptable outcome.