The Versatility of Lateral Chest Wall Perforator Flaps in Immediate and Delayed Breast Reconstruction: Retrospective Study of Clinical Experience with 26 Patients

Abstract

Rationale: Lateral chest flaps represent versatile reconstructive options, especially valuable in times of global healthcare resource restriction. In this series, we present our experience with the use of lateral chest wall flaps in both immediate and delayed reconstruction from both breast conserving and mastectomy surgery. Methods: A retrospective cohort study of patients who had undergone a lateral chest wall flap for immediate or delayed breast reconstruction of a lumpectomy or mastectomy defect was performed. Data collected consisted of patient demographics, procedure type, tumor/oncological characteristics, as well as postoperative complications. Findings: Between September 2015 and April 2021, 26 patients underwent breast reconstruction using a lateral chest wall flap. Fifteen patients (58%) underwent immediate reconstruction (9 lumpectomy; 6 mastectomy) and 11 (42%) underwent delayed breast reconstruction. All flaps survived, though 1 patient required partial flap debridement following venous compromise hours after surgery. There were no incidences of hematoma, seroma, infection, or wound healing delay at either the donor site or breast. There was one positive margin which occurred in a mastectomy patient. Significance: This study describes the use of lateral chest wall flaps in a wide variety of reconstructive breast surgery scenarios. This technique can be safely performed in an outpatient setting and does not require microvascular techniques. Review of our outcomes and complications demonstrate that this is a safe and effective option. Our experience is that this is an easy to learn, versatile flap that could be a valuable addition to the surgeon's arsenal in breast reconstruction.

Local Flaps to Cover Skin Necrosis after Skin-sparing Mastectomy and Prepectoral Reconstruction from PreQ-20 Trial

“…18 Local flaps have been used mainly to resolve the complications of breastconservative surgery 19 and have recently been implemented as a volume replacement technique in oncoplastic surgery. [22][23][24][25] These skin flaps are classified as axial and random according to the origin of their vascular supply. Axial flaps depend on an arterial pedicle at its base, and their design depends on the direction and length of the vessel, requiring identification and dissection of the pedicle.…”

“…18 Local flaps have been used mainly to resolve the complications of breast-conservative surgery 19 and have recently been implemented as a volume replacement technique in oncoplastic surgery. 22–25…”

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

“…There is an extreme paucity of data for this. Retrouvey et al in their study from 2021 reported on six patients with mastectomy undergoing reconstruction with CWPFs [ 19 ]. But their study was heterogeneous, also including some patients where both expander and CWPF were used.…”

Algorithms for perforator-based flaps in different anatomical locations

“…Yıldırım et al (3) suggested that as in the conventional perforator flaps, perforator-based flaps can also be planned in any anatomic location when there is detectable perforator present by a hand-held Doppler ultrasound. Concordantly, studies have showed that different perforator-based flaps can be planned in different designs for different anatomical locations as lower extremity (4), upper extremity (5), trunk (6), face (7) or scrotal area (8).…”