Breast Reconstruction Using the Lateral Thoracic, Thoracodorsal, and Intercostal Arteries Perforator Flaps

Abstract

Background: Breast-conserving surgery followed by radiotherapy represents the standard of care for early-stage breast cancer. The aim of this article was to provide a review of the literature about the use of the lateral thoracic artery perforator (LTAP) flap, the lateral thoracodorsal (LTD) flap, and the lateral intercostal artery perforator (LICAP) flap in lateral partial breast defect. Methods: A literature search was performed via PubMed, Medline, and Cochrane. Patient’s characteristics, topography and size of breast defect, flap size and design, number of perforators, and operative time were analyzed. Aesthetic and patient-reported outcomes, postoperative complications, and donor site morbidity were also registered. Results: Thirteen articles fulfilled inclusion criteria, and 432 patients were included. Different flap designs and flap combinations were described. Satisfactory outcomes were reported for between 78% and 100% of cases. Patient satisfaction ranged from 75.8% to 92.5% of cases. The overall complication rate was 9.25%, and donor site morbidity was very low (3.7%). Conclusions: A distinct advantage of LTAP, LTD, and LICAP flap reconstruction is that the thoracodorsal pedicle is not sacrificed, not compromising eventual delayed breast reconstruction with TDAP or latissimus dorsi flaps. This staged approach to partial breast reconstruction is especially useful in cases where the oncological margins are uncertain and wider resections (or mastectomies) are secondly required.

The Intercostal Artery Perforator Flap

“…In these scenarios, traditional methods of intraparenchymal redistribution and therapeutic breast reduction are not amendable given the paucity of tissue, nipple, and/or skin. The utility of the ICAP flap for volume replacement in breast reconstruction has been well documented in the literature 10–16 . Intercostal artery perforator flaps offer a modality of volume restoration that expands BCT candidacy and subsequently avoids mastectomy in a subset of patients.…”

“…In cases with a paucity of remaining breast, the recruitment of surrounding tissue is necessary 7 . One technique that has been well reported in the literature is the recruitment of upper abdominal wall tissue based on intercostal artery perforating vessels 10–16 . Those supplied by named anterior or lateral intercostal artery perforating vessels are referred to as the intercostal artery perforator (ICAP) flap.…”

“…7 One technique that has been well reported in the literature is the recruitment of upper abdominal wall tissue based on intercostal artery perforating vessels. [10][11][12][13][14][15][16] Those supplied by named anterior or lateral intercostal artery perforating vessels are referred to as the intercostal artery perforator (ICAP) flap. Although its utility for volume replacement has been well articulated, it has previously not been described for NAC reconstruction or resurfacing of the skin envelope after NAC or major cutaneous resections.…”

Pushing the Boundaries of Pedicled Chest Wall Perforator Flaps in Oncoplastic Breast Surgery

“…For the patients where skin excision was required in the outer half of the breast, they underwent LTAP/LICAP to provide volume replacement and skin cover after tumour excision. LTAP/LICAP was harvested as per standard technique and was rotated in a propeller fashion into the defect [ 13 ].…”

Oncoplastic Breast Conservation: A Standard of Care in Modern Breast Cancer Surgical Management

“…However, additional scars, donor site morbidity and a higher risk of complications associated with these techniques mandate additional surgical training, as well as appropriate patient selection. A detailed description of the techniques is available widely across the literature [42][43][44][45][46] and is beyond the scope of this chapter.…”