Lateral chest wall perforator flaps in partial breast reconstruction

Abstract Background Breast conserving surgery (BCS) has been a standard procedure for the treatment of breast cancer instead of mastectomy whenever possible. Lateral chest wall perforator flaps are one of the volume replacement techniques that participate in increasing the rate of BCS especially in small- to moderate-sized breasts with good cosmetic outcome. In this study, we tried to evaluate the outcome of those flaps as an oncoplastic procedure instead of the conventional flaps. Methods This study included 26 patients who underwent partial mastectomy with immediate reconstruction using lateral chest wall perforator flaps in the period from October 2019 to November 2020. The operative time, techniques, and complications were recorded. The cosmetic outcome was assessed 3 months post-radiation therapy through a questionnaire and photographic assessment. Results Lateral intercostal artery perforator (LICAP), lateral thoracic artery perforator (LTAP) and combined flaps were performed in 24, 1, and 1 patients, respectively. The mean operative time was 129.6 ± 13.2 min. The flap length ranged from 10 to 20 cm and its width from 5 to 9 cm. Overall patients’ satisfaction was observed to be 88.5% as either excellent or good and the photographic assessment was 96.2% as either excellent or good. Conclusions Lateral chest wall perforator flaps are reliable and safe option for partial breast reconstruction with an acceptable aesthetic outcome. In the era of oncoplastic breast surgery, they deserve to gain attention especially with the advantages of some modifications added to the classic technique.

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Chest wall perforator flaps for partial breast reconstruction: Surgical outcomes from a multicenter study

Archives of Plastic Surgery ◽

10.5999/aps.2019.01186 ◽

2020 ◽

Vol 47 (2) ◽

pp. 153-159 ◽

Cited By ~ 1

Author(s):

Soni Soumian ◽

Rishikesh Parmeshwar ◽

Mihir Chandarana ◽

Sekhar Marla ◽

Sankaran Narayanan ◽

...

Keyword(s):

Breast Reconstruction ◽

Chest Wall ◽

Surgical Outcomes ◽

Breast Conserving Surgery ◽

Patient Reported Outcome Measures ◽

Perforator Flaps ◽

Lateral Thoracic Artery ◽

Patient Reported ◽

Artery Perforator

Background Perforator artery flaps based on the branches of intercostal arteries and lateral thoracic artery can be used for reconstruction after breast-conserving surgery (BCS). Although described more than a decade ago, these have not been adopted widely in clinical practice. We report on short-term and long-term surgical outcomes of partial breast reconstruction using chest wall perforator flaps from a prospective multicenter audit.Methods All patients operated for BCS and partial breast reconstruction using intercostal artery perforator or lateral thoracic artery perforator flaps from January 2015 to October 2018 were included in the analysis. Oncoplastic breast surgeons with appropriate level of training performed all tumor excisions and reconstructions as a single-stage procedure. Patient characteristics, treatment details and surgical outcomes were noted. Specific outcomes recorded were margin re-excision and complication rates.Results One hundred and twelve patients underwent the procedure in the given study period. The median age was 54 years. Median specimen weight was 62.5 g and median volume of excision was 121.4 mL. Fifteen patients (13.39%) underwent a margin re-excision for close or positive margins without additional morbidity. One patient required a completion mastectomy. Eight patients (7.14%) had an early complication. None of the patients required a contralateral symmetrization procedure. The results were comparable across the participating centers.Conclusions Chest wall artery perforator-based flaps are an excellent option for lateral and inferior quadrant partial breast reconstructions. The short and long-term surgical outcomes are comparable across sites and can be performed with minimal morbidity. Patient-reported outcome measures need to be studied.

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Thoracodorsal Artery Perforator and Superior Epigastric Artery Perforator Flaps for Volume Replacement Oncoplastic Breast Surgery

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-3400688 ◽

2019 ◽

Vol 52 (03) ◽

pp. 304-308

Author(s):

Dushyant Jaiswal ◽

Prabha Subhash Yadav ◽

Vinay Kant Shankhdhar ◽

Tasneem Jaffer Belgaumwala

Keyword(s):

Breast Surgery ◽

Breast Conservation ◽

Volume Replacement ◽

Partial Mastectomy ◽

Perforator Flaps ◽

Oncoplastic Breast Surgery ◽

Skin Paddle ◽

Epigastric Artery ◽

Thoracodorsal Artery ◽

Artery Perforator

Abstract Introduction Breast conservation therapy (BCT) and oncoplastic breast surgery (OBS) are now established modalities of treatment for breast cancer, with proven oncological safety. Traditionally, latissimus dorsi (LD) flaps have been the one-stop solution workhorse when volume replacement is needed. We present our experience with thoracodorsal artery perforator (TDAP) and superior epigastric artery perforator (SEAP) flaps. These flaps allow the preservation of muscle structure and function. Material and Methods Data were collected prospectively of patients in whom pedicled perforator flaps after BCT were used. A handheld 8-MHz audio Doppler was used to locate the perforators. TDAP flaps were used in four patients, whereas SEAP flaps were used in two patients. Skin paddle sizes ranged from 10 × 3 cm to 21 × 7 cm. Results TDAP flaps were used in four patients, whereas SEAP flaps were used in two patients All flaps survived. No flap had partial necrosis or fat necrosis. All donor sites were closed primarily and healed uneventfully, and none had a seroma requiring aspiration. Conclusion TDAP flaps can be selectively employed when the LD muscle function needs to be preserved. SEAP flaps can also be employed as a rare option in case of lower inner quadrant defects. Pedicled perforator flaps are a useful and reliable option for volume replacement OBS in select patients for reconstructing partial mastectomy defects.

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The impact of partial breast reconstruction with lateral chest wall perforator flaps on post-operative cancer surveillance

Annals of Breast Surgery ◽

10.21037/abs.2018.04.01 ◽

2018 ◽

Vol 2 ◽

pp. 10-10

Author(s):

Jesse Hu ◽

Alexandra Tenovici ◽

Vaishali Parulekar ◽

Madhu Bhattacharyya ◽

Pankaj G. Roy

Keyword(s):

Breast Reconstruction ◽

Chest Wall ◽

Cancer Surveillance ◽

Perforator Flaps ◽

Lateral Chest ◽

The Impact

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One-stage vs. two-stage approach for partial breast reconstruction with lateral chest wall perforator flaps

Cancer Treatment and Research Communications ◽

10.1016/j.ctarc.2016.06.003 ◽

2016 ◽

Vol 9 ◽

pp. 56-61 ◽

Cited By ~ 4

Author(s):

Pankaj Gupta Roy

Keyword(s):

Breast Reconstruction ◽

Chest Wall ◽

Two Stage ◽

Perforator Flaps ◽

One Stage ◽

Lateral Chest

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LICAP Versus TDAP for Reconstruction of Partial Breast Defects

10.21203/rs.3.rs-1030583/v1 ◽

2021 ◽

Author(s):

Tarek Hashem ◽

Sherif N Taha ◽

Ahmed Oraby

Keyword(s):

Chest Wall ◽

Perforator Flap ◽

Cosmetic Outcome ◽

Complication Rates ◽

Perforator Flaps ◽

Posterior View ◽

Reconstructive Option ◽

Thoracodorsal Artery Perforator Flap ◽

Tdap Flap ◽

Artery Perforator

Abstract BackgroundPerforator 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 reconstruction of partial breast defects.MethodsPatient records were reviewed for the time period between 2011-2019 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 antro-posterior view. The photographs were later processed via BCCT.core software to obtain an objective cosmetic outcome assessment.ResultsComplication rates and cosmetic outcome were comparable for both techniques. TDAP flap 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.ConclusionPedicled chest wall perforator flaps constitute an excellent reconstructive option in partial breast defects. They have replaced musculocutaneous flaps to a large extent.

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Designing Lateral Thoracic Wall Perforator Flaps for Breast Reconstruction Using the Ultrasound

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1740127 ◽

2021 ◽

Author(s):

Marzia Salgarello ◽

Giuseppe Visconti

Keyword(s):

Breast Reconstruction ◽

Duplex Ultrasound ◽

Free Flaps ◽

Thoracic Wall ◽

Perforator Flaps ◽

Thoracodorsal Artery ◽

The Us ◽

Latissimus Dorsi Myocutaneous Flap ◽

Artery Perforator ◽

Color Duplex Ultrasound

Abstract Background Lateral thoracic flaps represent a precious source for partial and total breast reconstruction, in some cases as first option and in other cases as alternative of free flaps. This article describes the ultrasound (US)-based planning of the lateral thoracic wall perforator adipocutaneous flaps and it reports our experience on 52 consecutive flaps. Patients and Methods From November 2018 to May 2021, 52 consecutive lateral thoracic wall perforator flaps were performed using the US-based method for reconstruction of partial breast defects and total breast reconstruction. High-frequency US was performed in all cases prior to surgery to select the best perforator and design the flap. Results Of the 52 cases, 41 were lateral intercostal artery perforator flaps (78.8%), and 11 were thoracodorsal artery perforator (TDAP) flaps. Of the 11 TDAP flaps, 2 cases were based on the direct cutaneous branch. Moreover, in two other cases clinically scheduled for lateral thoracic perforator flaps due to the presence of an appropriate axillary roll, no suitable local/regional perforators were detected with the preoperative US examination and the latissimus dorsi myocutaneous flap was performed. Conclusion Preoperative planning of these flaps using US speeds the surgery and makes it easier and more efficient. Therefore, it is reasonable that the color duplex ultrasound is the operative surgeon's tool for mapping the lateral thoracic wall perforators and to appropriately plan each flap.

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PR21ï¿½PLANNING GLUTEAL ARTERY PERFORATOR FLAPS FOR BREAST RECONSTRUCTION WITH PREOPERATIVE IMAGING

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2009.04927_21.x ◽

2009 ◽

Vol 79 ◽

pp. A58-A58

Author(s):

D. G. Grinsell ◽

W. M. Rozen

Keyword(s):

Breast Reconstruction ◽

Preoperative Imaging ◽

Perforator Flaps ◽

Artery Perforator

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Anterior Intercostal Artery Perforator Flap as a Simple Technique for Partial Breast Reconstruction: Our Institutional Initial Experience

Tumori Journal ◽

10.1177/0300891620931670 ◽

2020 ◽

Vol 106 (1_suppl) ◽

pp. 40-40

Author(s):

R Amira Maher ◽

Ahmed Gamal Eldin Osman ◽

K Fahmy ◽

Nouf M. Ebied ◽

Reda Eissa

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Perforator Flap ◽

Cosmetic Outcome ◽

University Hospital ◽

Intercostal Artery ◽

Breast Size ◽

Cancer Management ◽

The Mean ◽

Artery Perforator

Background: The oncoplastic surgery has brought new dimensions to breast conserving surgery and added the aesthetic principles of breast surgery to breast cancer management. Recently there's a lot of volume replacement techniques without significant donor site morbidity .The anterior intercostal artery perforator (AICAP) flap is a suitable option in partial breast reconstruction for lower pole tumors in small and medium sized breasts. Objectives: The aim of this study is to report our clinical experience with anterior intercostal perforator flap in partial breast reconstruction Methodology: 25 cases were performed between April 2018 to June 2019 at in Ain shams university hospitals for selected patients with lower breast pole tumors with small and medium sized breast and other option like reduction mMDTmoplasty wasn't favorable for them. Results: A total of 25 patient were selected by the multidisplinary team at Ain shams university hospital for partial breast reconstruction with anterior intercostal artery perforator flap . The mean age of the cases was 45.68 with mean body mass index of 32.32. The mean operative time for the flap was 64 minutes while the hospital stay was ranging from 1-2 days .Follow-up for local recurrence was from 6 to 14 months. There was 1 case with wound complication (4%). The cosmetic outcome was assessed by the MDT and a giving score from 1-5 was used with 1 is the least favorable cosmetic outcome and 5 is the best result 76% of the cases scored 5, 14% scored 4, 8% scored 3. According to patient satisfaction a score from 1 to 5 was used with the score 1 is least satisfied and score 5 represents the most satisfaction level, there was 80% of the patient gave the score 5, 12% of the cases gave the score 4 and 8% of the cases gave the score 3 Conclusions: Based on our experience, partial breast reconstruction using AICAP flap is a reliable option for lower breast tumors in small-to-moderate breast size with perfect cosmetic outcome and negligible rate of complication.

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Improvement in Existing Chest Wall Irregularities During Breast Reconstruction

Cancer Control ◽

10.1177/1073274817744461 ◽

2018 ◽

Vol 25 (1) ◽

pp. 107327481774446

Author(s):

Katherine M. Huber ◽

Amanda Zimmerman ◽

Deniz Dayicioglu

Keyword(s):

Patient Satisfaction ◽

Breast Reconstruction ◽

Risk Reduction ◽

Chest Wall ◽

Pectus Excavatum ◽

Case Reports ◽

Cosmetic Outcome ◽

Cancer Resection

Mastectomies for both cancer resection and risk reduction are becoming more common. Existing chest wall irregularities are found in these women presenting for breast reconstruction after mastectomy and can pose reconstructive challenges. Women who desired breast reconstruction after mastectomy were evaluated preoperatively for existing chest wall irregularities. Case reports were selected to highlight common irregularities and methods for improving cosmetic outcome concurrently with breast reconstruction procedures. Muscular anomalies, pectus excavatum, scoliosis, polythelia case reports are discussed. Relevant data from the literature are presented. Chest wall irregularities are occasionally encountered in women who request breast reconstruction. Correction of these deformities is possible and safe during breast reconstruction and can lead to improved cosmetic outcome and patient satisfaction.

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