Utility of Two Surgical Techniques Using a Lateral Intercostal Artery Perforator Flap after Breast-Conserving Surgery: A Single-Center Retrospective Study

Abstract

Background: Immediate partial breast reconstruction after breast-conserving surgery has become a new paradigm in treating breast cancer. Among the volume replacement techniques used for small to moderate-sized breasts, the perforator flap method has many advantages. The authors present anatomical studies and two surgical techniques using lateral intercostal artery perforator flaps. Methods: Data from 40 patients who underwent breast reconstruction using the lateral intercostal artery perforator flap between January of 2011 and June of 2016 were included. The authors conducted comparative analyses of the propeller flap and the turnover flap. They used three-dimensional computed tomography in lateral intercostal artery perforator flap anatomical studies, analyzing the distribution probability of the dominant perforator, the vertical distance from the axillary fold, and the horizontal distance from the anterior border of the latissimus dorsi. Results: The most dominant perforator used for lateral intercostal artery perforator flaps was the sixth lateral intercostal artery perforator (43.6 percent of cases), followed by the seventh lateral intercostal artery perforator (39.1 percent of cases); their mean distances from the latissimus dorsi and the axillary folds were determined and reported. Complications included three cases requiring additional treatment for fat necrosis (propeller method, two cases; turnover method, one case) and venous congestion in only two cases that used the propeller method. Cosmetic satisfaction was 90 percent or greater for both techniques, indicating that results were rated as either excellent or good. Conclusion: The authors believe that their study results can broaden the application of partial breast reconstruction by using the lateral intercostal artery perforator flap after breast-conserving surgery, with three-dimensional computed tomography for anatomical studies, and using one of the authors’ two described surgical techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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

“…In Total, 4 studies described partial breast reconstruction using LTAP flap 25 , 26 , 29 , 32 (combined with LICAP flap in some patients in 3 studies 25 , 26 , 32 ), 3 studies described partial breast reconstruction using LTD flap, 20 , 23 , 24 and 6 studies described partial breast reconstruction using LICAP flap. 21 , 22 , 27 , 28 , 30 , 31 A total of 432 patients were included, and the sample size of each study ranged from 8 to 87 patients. From the 432 included patients, 176 patients underwent an LTAP flap reconstruction (a combined LTAP + LICAP flap reconstruction in 103 cases), 76 patients underwent an LTD flap reconstruction, and 180 patients underwent an LICAP flap reconstruction.…”

“…Hamdi 21 and Roy 26 suggested performing Doppler evaluation, with the patient lying down simulating the intraoperative position. In addition, 2 studies 27 , 31 described that all patients underwent a 3-dimensional chest computed tomography angiography preoperatively to identify the dominant perforator vessel by its relationship with the LD muscle. Based on this location, a Doppler mapping was used to recheck the perforator, and the skin was marked for use during the design phase.…”

“…4 ). Moreover, 1 author 31 described that for cases requiring eventual additional volume replacement because of oncologic problems, other flaps (such as the thoracodorsal artery perforator flap) were preoperatively designed.…”

“…Three studies described either turnover or propeller flaps. Kim 31 reported 29 cases of “propeller LICAP flap” and 11 cases of “turnover LICAP flap” (Fig. 6 ).…”

“…Aesthetic outcomes following LICAP flap were evaluated subjectively by surgeons as good to excellent (considering symmetry, shape and volume) in 100%, 78%, 100%, and 92.5% of cases in 4 studies. 27 , 28 , 31 , 32 In addition, Roy 25 reported that 82% of patients achieved good or excellent aesthetic outcomes, using the Harris Scale. Kim 31 compared aesthetic results in patients undergone “LICAP propeller” versus “LICAP turnover” flap and reported no significant statistical difference.…”