Safety and efficacy of anterior intercostal artery perforator flaps in oncoplastic breast reconstruction

Abstract

Introduction Partial breast reconstruction based on the anterior intercostal artery perforators (AICAP) has been suggested to avoid the unsightly ‘bird's beak’ deformity for lower pole breast cancers. The aims of this study were to evaluate the initial clinical experience of AICAP flaps in terms of safety and efficacy in oncoplastic breast reconstruction. Methods Between October 2013 and April 2020, AICAP flaps were offered to 30 patients with lower pole breast cancers. Hand‐held Acoustic Doppler assessments were undertaken to confirm adequate perforators. Surgical results were evaluated in terms of safety and efficacy. Patients were invited to complete sections of the Breast‐Q questionnaire at least 12 months postoperatively to assess patient satisfaction in terms of cosmetic outcome, physical and psychosocial wellbeing. Results Median operating theatre time for AICAP flap harvesting and positioning was 20 min (range 15–28 min). The median weight of resected breast specimens was 41 g (range 10–127 g). Total tumour size ranged from 7 to 35 mm (median 16 mm; three cases exhibited multifocal disease). Clear radial resection margins were achieved in 29 cases (96.7%). The median post‐operative stay was two days (range 2–3 days). There were two postoperative complications comprising delayed wound healing/fat necrosis, which resolved with monitoring and inadine dressings. Based on the Breast‐Q results, patients reported high levels of satisfaction with the physical appearance of their reconstructed breast, psychosocial and physical wellbeing. Conclusion AICAP flaps appear to be safe in restoring breast contour after wide excision of lower pole breast cancers, with high levels of patient satisfaction reported postoperatively.

Smartphone Dynamic Infrared Thermography for Harvesting AICAP Flap in a Large Breast-conservative Surgery

“…10,11 These flaps have been validated in terms of reliability and versatility by several studies that guarantee the survival of pans wrapped around 16 × 5 cm, with a pedicle composed of only one of these perforating. 12 Our study documents how smartphone DIRT is a rapid, sensitive, easily accessible, and cost-effective diagnostic method for the topographical identification of intercostal artery perforators.…”

Extreme oncoplasty: past, present and future

“…Some studies mentioned breast sized/tumour size ratio or resection size to breast size ratio ( 35 , 36 ), which can be used for small- and medium-sized breasts, using regional tissue transfer with local/regional flaps ( 18 , 35 – 37 ). We also observed new options, such as regional flaps ( 38 – 47 ), partial breast amputation ( 48 – 51 ), and flap guides for central tumours ( 52 ). It is important to accept and include these new indications in the spectrum of EO.…”

“…They are usually performed in a nonstandard way for patients in whom preservation of the breast is desired and cosmesis is not the primary endpoint. These techniques are locoregional flaps ( 37 , 38 , 40 – 47 , 52 , 55 ) and nonpedicled flaps, such as thoracoepigastric, thoracic-lateral, and bilobed flaps ( 55 ). It is necessary to accept and group these new techniques, allowing other reviews in the future.…”