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Vindigni V, Marena F, Zanettin C, Bassetto F. Breast Reconstruction: The Oncoplastic Approach. J Clin Med 2024; 13:4718. [PMID: 39200860 PMCID: PMC11355501 DOI: 10.3390/jcm13164718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/28/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Breast reconstruction surgery is continualladvancing, significantly enhancing patient well-being. Current surgical techniques prioritize minimizing donor site morbidity while achieving a more natural breast appearance. Increasing patient preferences for avoiding prosthetic materials in reconstruction, along with advancements in oncological safety and heightened aesthetic expectations, are driving the exploration and development of innovative approaches. Today's reconstructive options range from straightforward oncoplastic glandular remodeling to intricate microsurgical procedures. This narrative review, titled "Breast reconstruction: the oncoplastic approach," provides a comprehensive overview of contemporary trends in breast-conserving treatment. It evaluates the indications for these techniques and offers guidance to plastic surgeons in crafting personalized treatment plans. This approach presents a valuable single-stage alternative or adjunct to traditional prosthetic or microsurgical reconstruction methods.
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Affiliation(s)
| | - Francesco Marena
- Unit of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (V.V.); (C.Z.); (F.B.)
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Lombardo GAG, Stivala A, Ciancio F, Tamburino S, D'Antonio GM, Catalano F, Ranno R. A before and after evaluation of patient reported outcomes assessed by Breast Q following LICAP turnover flap in breast conservative therapy. Updates Surg 2024; 76:1047-1054. [PMID: 38071239 DOI: 10.1007/s13304-023-01714-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/18/2023] [Indexed: 05/28/2024]
Abstract
Chest-wall perforator-based techniques to replace volume for breast conservative therapy allow excision of large breast areas with minimal sequalae, such as the nipple-areolar complex displacement, parenchymal indentation or contour deformity. Furthermore, chest wall perforator flaps facilitate the maintenance of breast symmetry, hence decreasing the need for contralateral surgery. Lateral intercostal flap was described in numerous variants among which the most famous are the propeller flap and the turnover version. The turnover version is the easiest and fastest version that allows the replacement of large amount of volume. In this paper, we evaluate patients reported outcomes, before and after surgery, collected through the Breast Q. This study was conducted on 21 patients who were admitted to the plastic surgery department. A prospectively maintained database was used to identify the patients and their records were assessed retrospectively. The pre/post operative patients data were collected. The Breast-Q questionnaire was administered before the surgery and at least 1 year after. No major surgical complications were reported. Mean Breast-Q scores were evaluated at least 1 year after surgery and radiotherapy and compared with pre-surgical scores. Among all the modules, no significant differences between the pre-surgical and post-surgical Breast-Q scores were observed. Until now, the lateral intercostal artery perforator flap has not been widely used, due to a difficult dissection and a challenging preoperative planning. According to the reported surgical technique, the execution is easy. This technique provides the same breast-related quality of life compared to preoperative values, reduces the mastectomy rate and increases the overall survival.
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Affiliation(s)
- Giuseppe A G Lombardo
- Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Via Messina, 829, Catania, Italy.
- Plastic, Reconstructive and Aesthetic Surgery, Università Unikore Di Enna, Piazza Dell'Università, 94100, Enna, EN, Italy.
| | - Alessio Stivala
- Plastic, Reconstructive and Aesthetic Surgery, Centre Hospitalier de Mâcon, 350 Boulevard Louis Escande, 71000, Mâcon, France
| | - Francesco Ciancio
- Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Via Messina, 829, Catania, Italy
| | - Serena Tamburino
- Chi.Pla Chirurgia Plastica Private Office, Via Suor Maria Mazzarello 54, Catania, Italy
| | - Giovanni Maria D'Antonio
- Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Via Messina, 829, Catania, Italy
| | - Francesca Catalano
- Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina, 829, Catania, Italy
| | - Rosario Ranno
- Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Via Messina, 829, Catania, Italy
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Agrawal SK, Mahajan S, Ahmed R, Shruti N, Sharma A. Chest wall perforator flap partial breast reconstruction: a retrospective analysis of surgical, cosmetic and survival outcome. Ecancermedicalscience 2024; 18:1681. [PMID: 38566767 PMCID: PMC10984835 DOI: 10.3332/ecancer.2024.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Oncoplastic breast surgery includes volume replacement as well as volume displacement. Autologous tissue is the preferred approach for volume replacement and includes chest wall perforator flaps (CWPF). Although described more than a decade ago, CWPFs have not been adopted widely in clinical practice till recently. We report the largest single-centre institutional data on CWPFs. Patients and methods The study includes all patients who underwent breast conservation surgery (BCS) using CWPFs from January 2015 to December 2022. Data were retrieved from the institutional electronic record and Redcap database. The analysis was done using SPSS 23 and STATA 14. Results 150 patients were included in the study. The mean age was 48.8 years (SD 10.4), and the body mass index was (26.6 kg/m2, SD 4.3). >50% of patients had breasts with small cup sizes (A&B) and mild ptosis (Non-ptotic and Grade 1 ptosis). 44.7% of patients underwent lateral intercostal artery perforator flap (LICAP), anterior intercostal artery perforator flap in 31.3%, lateral thoracic perforator flap (LTAP) in 12%, LICAP + LTAP in 11.3% and thoracodorsal artery perforator flap in 1%. Post-operatively, haematoma was seen in 1.3%, complete flap necrosis in 1.3%, seroma in 7%, wound dehiscence in 12%, and positive margin in 6.7%. 92 patients responded to the satisfaction assessment, of which >90% were happy with the surgical scars, comfortable going out in a public place, satisfied with the symmetry of the breast, and no one chose mastectomy in hindsight. The 5-year predicted disease free survival and overall survival were 86.4% and 94.7%, respectively. Conclusion BCS with CWPF is an excellent option for reconstruction in small to medium-sized breasts. It is associated with minimal morbidity and comparable patient-reported cosmetic and survival outcomes.
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Affiliation(s)
| | | | - Rosina Ahmed
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
- Equally contributed
| | - Neela Shruti
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
- Equally contributed
| | - Abhishek Sharma
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
- Equally contributed
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Korayem IM, Ramadan R, Fayed H. Feasibility and early cosmetic outcome of modified lateral intercostal artery perforator flap after breast conservative surgery. BMC Surg 2024; 24:75. [PMID: 38431543 PMCID: PMC10908061 DOI: 10.1186/s12893-024-02367-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The lateral intercostal artery perforator (LICAP) flap aims at replacing the excised breast lump with axillary tissue rich blood supply. The purpose of this study is to report the initial results of a modification LICAP flap technique in terms of intraoperative technical feasibility and short-term cosmetic outcomes in the early postoperative period. METHODS Modified LICAP flap technique was performed on 36 female patients with pathologically proven BC located in the outer half of the breast in the period from June 1, 2021, to April 30, 2022. RESULTS The LICAP flap modification enabled performing the procedure with the patient in supine position without repositioning. The majority of the patients (90%) had satisfactory early cosmetic results as reported by the patients and oncoplastic independent surgeon. CONCLUSION Modified LICAP flap reconstruction is feasible to be performed with the patient in supine position without repositioning and it has satisfactory early cosmetic outcomes.
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Affiliation(s)
- Islam M Korayem
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Rabie Ramadan
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Haytham Fayed
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Rankin AC, Almalki H, Mirshekar-Syahkal B, Hussien MI. The Extended Chest Wall Perforator Flap: Expanding the Indication for Partial Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5697. [PMID: 38533519 PMCID: PMC10965203 DOI: 10.1097/gox.0000000000005697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
Background The intercostal artery perforator flap has traditionally been used to reconstruct small or moderate-sized single defects in the lateral or lower medial breast during breast-conserving surgery. We report a modification of the intercostal artery perforator flap that allows for reconstruction of larger breast tumors than previously described flap designs. Methods A retrospective study of breast cancer patients undergoing breast-conserving surgery and immediate partial breast reconstruction with an extended chest wall perforator flap. Primary outcomes were successful tumor excision, adequate radial margins, postoperative complications, and delays to adjuvant radiotherapy. Results Thirty patients were included. Mean radiological tumor size was 27 mm (11-56 mm) and excision volume, 123 cm3 (18-255 cm3). All tumors had satisfactory excision margins, and no patient required further surgery for re-excision. In the early postoperative period, one patient required radiological drainage of seroma, and one returned to theater for debridement of fat necrosis affecting the flap. Ten other patients were managed on an outpatient basis for minor wound complications. All patients were followed up annually for 5 years. No patients had a delay to adjuvant treatment or required revisional procedures for cosmesis. Conclusions The modified chest wall perforator flap allows for breast conservation for larger tumors from all quadrants of the breast, including centrally located tumors and reconstruction of the axillary defect following lymph node clearance. The length of the flap allows for the use of multiple perforators in the pedicle area and freedom of the flap to reach the defects. This can be performed with low morbidity and no delay to adjuvant radiotherapy.
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Affiliation(s)
- Adeline C. Rankin
- From the Department of Breast Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Hend Almalki
- From the Department of Breast Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Bahar Mirshekar-Syahkal
- From the Department of Breast Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Maged I. Hussien
- From the Department of Breast Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
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Huang S, Qiu P, Liang Z, Yan Z, Luo K, Huang B, Yu L, Crèvecoeur J, Winder AA, Zhang Y, Jiang H. Application of a modified lateral thoracic artery perforator flap in partial breast defects. Gland Surg 2024; 13:199-208. [PMID: 38455344 PMCID: PMC10915419 DOI: 10.21037/gs-23-529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024]
Abstract
Background Breast cancer has become the most frequently diagnosed cancer in the world. Detection at an early stage, frequently allows women to benefit from breast conserving surgery. However, some patients are not satisfied with the breast shape after breast-conserving surgery, and autologous tissue flaps are needed to fill the defect in the resection area. The modified lateral thoracic artery perforator (LTAP) flap isn't one of the commonly used flaps in breast surgery and has the advantages of a reliable blood supply, simple operation and few postoperative complications. In this study, we aimed to evaluate the feasibility and effectiveness of a modified LTAP flap for repairing partial breast defects after breast-conserving surgery. Methods In this study, we retrospectively analyzed the clinical data of 126 patients treated with LTAP flaps to repair local breast defects at Affiliated Hospital of Guangdong Medical University between January 2020 and June 2021. Data were collected on the demographic characteristics of these patients, tumor size and location, type of axillary lymph node surgery, availability of adjuvant chemotherapy and radiotherapy, and postoperative complications. Results The median weight of the tumor specimen was 185 g (range, 170-320 g), and this glandular tissue accounted for 30% to 40% of the total breast volume. The average flap size was 10.5 cm ×2.5 cm (length range, 8-15 cm, width range: 2-4 cm). The minimum follow-up time was 6 months, with an average of 10 months (range, 6-22 months). The mean operative time was 130 minutes (range: 90-180 minutes), and the mean hospital stay was 3 days (range, 2-5 days). All modified LTAP flaps survived completely without donor site complications. None of the patients required revision surgery on the postoperative breast. Conclusions The modified LTAP flap is a reliable method for repairing partial breast defects after breast-conserving surgery. It has the advantages of a simple operation, a reliable blood supply, fewer postoperative complications, and a high flap survival rate. It is especially suitable for Asian women with small breast volumes and can achieve good breast contouring effects.
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Affiliation(s)
- Shengchao Huang
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Pu Qiu
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhongzeng Liang
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zeming Yan
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Kangwei Luo
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Baoyi Huang
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Liyan Yu
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | | | - Alec Anthony Winder
- Department of General Surgery, Townsville University Hospital, Townsville, Australia
| | - Yuanqi Zhang
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Haiping Jiang
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Russell Pinto T, Mora H, Peleteiro B, Magalhães A, Gonçalves D, Fougo JL. Chest wall perforator flaps for partial breast reconstruction after conservative surgery: Prospective analysis of safety and reliability. Surg Oncol 2023; 51:102015. [PMID: 38016381 DOI: 10.1016/j.suronc.2023.102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/06/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Breast-conserving surgery associated with adjuvant radiotherapy is the state of the art in the surgical treatment of breast cancer. Oncoplastic surgery through dermo-adipose flaps based in perforating arteries (muscle sparing flaps) for partial reconstruction is increasingly used as a good option for avoiding musculocutaneous flaps. In this study we evaluate the outcomes of the use of chest wall perforator flaps in the replacement of partial breast volume. METHODS A prospective cohort study of female patients that underwent a conservative oncoplastic surgery procedure with partial breast reconstruction using a dermo-adipose flap of perforating arteries of the chest wall was conducted between November 2020 and March 2022 at our centre. Primary outcomes were surgical morbidity, positive margins and reoperation rates. Characteristics associated with the occurrence of complications were further identified. RESULTS Forty-five patients underwent the procedure of interest during the study period. The mean age was 55 years. The median larger dimension of the tumor was 23 mm. Lateral intercostal artery perforator (LICAP), lateral thoracic artery perforator (LTAP), a combined flap and Anterior Intercostal Artery Perforator/Medial Intercostal Artery Perforator (AICAP)/(MICAP) were performed in 22, 16, 2 and 5 patients, respectively. The mean operative time was 126 min. A total of 9 (20.0%) patients required a reoperation after definitive diagnosis, 4 due to positive margins and 5 due to immediate/early surgical morbidity. CONCLUSIONS Local perforator flaps in oncoplastic breast-conserving surgery are a good option for immediate reconstruction after conservative surgery, showing low morbidity and favourable outcomes.
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Affiliation(s)
| | - Henrique Mora
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Bárbara Peleteiro
- Faculty of Medicine, University of Porto, Portugal; Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal; EPI Unit, Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health, University of Porto, Portugal
| | - André Magalhães
- Laboratory for Integrative and Translational Research in Population Health, University of Porto, Portugal
| | - Diana Gonçalves
- Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal
| | - José Luís Fougo
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal
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Spinelli E, Angrigiani C, Rancati A, Dorr J, Rancati A, Nahabedian MY. The reverse LICAP flap: A laterally based submammary perforator flap for breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 84:157-164. [PMID: 37331037 DOI: 10.1016/j.bjps.2023.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION The traditional donor sites for autologous breast reconstruction include the abdomen, thigh, buttock, and posterior thorax. Herein, we describe the use of the reverse lateral intercostal perforator (LICAP) flap originating from the submammary region as an option for breast reconstruction. METHODS Fifteen patients (30 breasts) were included in this retrospective review. The procedure was performed for immediate reconstruction following a nipple sparing mastectomy utilizing an inframammary incision or an inverted T pattern with preservation of the fifth anterior intercostal perforator (n = 8), volume replacement after implant explantation (n = 5), and partial lower pole resurfacing with exteriorization of a portion of the LICAP skin paddle (n = 2). RESULTS Flap survival was achieved in all patients. Three flaps (10%) had 1-2 cm of intraoperative distal tip ischemia, which was managed by excision prior to inset and closure. At the 12-month postoperative follow-up, stable results with good nipple position, breast shape, and projection were achieved in all patients. CONCLUSIONS The reverse LICAP flap is a safe, effective, and reliable option for breast reconstruction following mastectomy.
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Affiliation(s)
| | - Claudio Angrigiani
- Hospital San Martín University of Buenos Aires School of Medicine, Argentina.
| | - Alberto Rancati
- Hospital San Martín University of Buenos Aires School of Medicine, Argentina
| | - Julio Dorr
- Hospital San Martín University of Buenos Aires School of Medicine, Argentina
| | - Agustin Rancati
- Hospital San Martín University of Buenos Aires School of Medicine, Argentina
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Retrouvey H, Mahoney MH, Pinchuk B, Jalil W, Somogyi R. The Versatility of Lateral Chest Wall Perforator Flaps in Immediate and Delayed Breast Reconstruction: Retrospective Study of Clinical Experience with 26 Patients. Plast Surg (Oakv) 2023; 31:261-269. [PMID: 37654533 PMCID: PMC10467436 DOI: 10.1177/22925503211051110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/05/2021] [Indexed: 09/02/2023] Open
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.
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Affiliation(s)
- Helene Retrouvey
- University of Toronto, North York General Hospital, Toronto, Ontario, Canada
| | - Mary-Helen Mahoney
- University of Toronto, North York General Hospital, Toronto, Ontario, Canada
| | - Brian Pinchuk
- University of Toronto, North York General Hospital, Toronto, Ontario, Canada
| | - Waqqas Jalil
- University of Toronto, North York General Hospital, Toronto, Ontario, Canada
| | - Ron Somogyi
- University of Toronto, North York General Hospital, Toronto, Ontario, Canada
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Adler N, Carmon E, Chapchay K, Billig A. Anterior intercostal artery perforator flap for immediate reconstruction following breast conservation surgery. Microsurgery 2023; 43:20-26. [PMID: 35312091 PMCID: PMC10078757 DOI: 10.1002/micr.30884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/08/2022] [Accepted: 03/11/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Oncoplastic breast surgery following breast conservation surgery (BCS) utilizes aesthetic breast reduction techniques, and these reconstructions entail either volume displacement or volume replacement depending on the size and location of the excised tumor. The anterior Intercostal flap (AICAP) for immediate reconstruction after BCS is scarcely described in the literature. In this study, we present our experience with the Anterior Intercoastal Artery Perforator flap in 16 patients with small breast sizes. PATIENTS AND METHODS Sixteen patients underwent lumpectomy followed by immediate reconstruction with Anterior ICAP flap between 2019 and 2021 at Hadassah University Hospital. Median age was 49 (range 28-67). Breast cup size, lumpectomy to breast size ration, defect measurements and location are provided. Flap design and flap in-setting was planned and executed according to the size and location of the defect determined at the time of surgery. Surgical technique is described. Diagram of proposed reconstruction according to defect location is proposed. RESULTS Flap dimensions clinically matched the defect size or were slightly larger due to anticipated shrinkage of tissue post radiation with mean of 5.4 × 3.9 × 3.75 cm (range of 2.5-13 × 2-13.2 × 0.8-4.5 cm). Complications, namely one seroma and one mild infection, were seen in two patients. Median follow up was 3 months after completion of radiation. All reconstructions were satisfactory by both surgeon and patient at last post-operative follow-up visit. CONCLUSION The anterior ICAP flap is an important addition to the armamentarium of immediate reconstruction options after BCS, particularly in patients smaller size breast sizes.
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Affiliation(s)
- Neta Adler
- Department of Plastic and Reconstructive Surgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Einat Carmon
- Department of General Surgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Katya Chapchay
- Department of Plastic and Reconstructive Surgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Allan Billig
- Department of Plastic and Reconstructive Surgery, Hadassah University Medical Center, Jerusalem, Israel
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Yee FZY, Lim EW, Seet YLM, Hing JX, Mok CW. Modified chest wall lateral intercostal artery perforator (MCW-LICAP) flap: a versatile flap in the era of oncoplastic breast surgery. ANZ J Surg 2023; 93:294-301. [PMID: 36566493 DOI: 10.1111/ans.18216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Breast reconstruction following oncological resection is becoming more common in recent years. In some ladies, implant reconstruction is not ideal due to significant implant visibility or palpability. Autologous reconstruction addresses the limitations of implant reconstruction but results in potential donor site morbidities. To date, there is no clear advantage ascribed to any technique. With appropriate selection, patients with adequate lateral mammary fold have the option of reconstruction with MCW-LICAP flap. We present our techniques and outcomes from a series of 29 patients who underwent MCW-LICAP flap. METHODS A retrospective review of consecutive patients who underwent curative resection for breast cancer with immediate MCW-LICAP flap reconstruction, between July 2018 to April 2022 was conducted. The techniques used with its variations along with video demonstrations are presented. RESULTS A total of 29 patients underwent 34 procedures. Nineteen breast conserving surgeries and 15 mastectomies were completed, and immediate reconstruction performed in all cases. Twenty-three patients had MCW-LICAP, 1 with a Stacked intercostal artery perforator (STICAP) flap, and 5 had MCW-LICAP combined with a Goldilocks mastectomy. There were no cases of complications requiring re-operation. All patients had acceptable time to adjuvant therapy with a median of 36 days. Learning curve analysis showed a significant reduction in operative time after the 6th case. CONCLUSION In our preliminary experience, MCW-LICAP flap is a safe, reliable, and versatile oncoplastic reconstruction option.
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Affiliation(s)
- Francis Zheng Yi Yee
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Ee Wen Lim
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Yert Li Melissa Seet
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Jun Xian Hing
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Chi Wei Mok
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
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Zeeshan S, Vohra LM, Shamsi US, Zahid N, Ali D, Khan N, Garusi C. A single centre experience of local perforator flaps in oncoplastic breast surgery; a cross-sectional study. Ann Med Surg (Lond) 2022; 84:104916. [DOI: 10.1016/j.amsu.2022.104916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
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Elzawawy EM, Kelada MN. Posterior intercostal flap: an anatomical study and best flap design. World J Surg Oncol 2022; 20:244. [PMID: 35902870 PMCID: PMC9331144 DOI: 10.1186/s12957-022-02711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background Posterior intercostal arteries perforators (PICAPs) and lateral intercostal arteries perforators (LICAPs) are great vascular pedicles. Between the 4th and 11th spaces, they arise from the thoracic aorta. These are large perforators that can be the basis of many flaps. Yet, these perforators are underrated as they are poorly studied and scarcely utilized in plastic reconstructions. Methods Twenty (ten males and ten females) adult cadaveric dissections were done on both sides to study the types, locations, and sizes of posterior intercostal perforators to help design flaps based on them in the best possible way. Perforators were assigned into one of 3 topographical zones of the back (medial, intermediate, and lateral). Results The skin of the back was divided into 3 vertical zones: medial, intermediate, and lateral. Posterior intercostal arteries perforators (PICAPs) were found in the medial and intermediate zones. Medial zone PICAPs were large and appeared at the medial border of erector spinae (Es). Intermediate zone PICAPs appeared at the lateral border of Es and passed through latissimus dorsi (Ld) before reaching the skin. Lateral zone perforators were branches of lateral intercostal arteries and were divided into 2 types: (1) posterior branches of lateral intercostal perforators: simply named posterior lateral perforators (PLs); they were small and present in most of the spaces, and (2) anterior branches of lateral intercostal perforators (LICAPs): they were large, dominant pedicles and were found mainly in the 4th to the 7th spaces. Conclusion PICAPs and LICAPs are constant and of enormous size and run for a great distance in the skin. They can be utilized as any type of flap.
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Affiliation(s)
- Ehab M Elzawawy
- Anatomy and Embryology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Melad N Kelada
- Anatomy and Embryology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
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14
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Salibian AA, Olson B, Shauly O, Patel KM. Oncoplastic breast reconstruction: Principles, current techniques, and future directions. J Surg Oncol 2022; 126:450-459. [PMID: 35452129 DOI: 10.1002/jso.26897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/06/2022]
Abstract
Oncoplastic breast reconstruction has improved esthetic results after breast-conserving surgery with low complication rates and stable oncologic outcomes. Basic principles can be applied across different volume displacement and replacement techniques including restoration of breast shape and symmetry through esthetic incisions while eliminating dead space. Technique selection is guided by several factors including breast size, resection-to-breast ratio, and patient desires. A surgeon familiar with all techniques will allow individualization of treatment and optimization of outcomes.
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Affiliation(s)
- Ara A Salibian
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Blade Olson
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Orr Shauly
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
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15
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Orabi A, Youssef MMG, Manie TM, Shaalan M, Hashem T. Lateral chest wall perforator flaps in partial breast reconstruction. J Egypt Natl Canc Inst 2022; 34:2. [PMID: 35001182 PMCID: PMC8743083 DOI: 10.1186/s43046-021-00100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
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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Affiliation(s)
- Ahmed Orabi
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Mina M G Youssef
- Norfolk and Norwich University Hospital, Norwich, UK.,Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Tamer M Manie
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Shaalan
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Tarek Hashem
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
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16
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Neamonitou F, Thekkinkattil D, Sukumar A, Prusty L, Vidya R. A Multicentric Prospective Cohort Study of Modified Lateral Intercostal Artery Perforator Flap in Partial Breast Reconstruction. Ann Plast Surg 2022; 88:14-19. [PMID: 34029283 DOI: 10.1097/sap.0000000000002838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Oncoplastic breast surgery is well established in many parts of the world and is gaining popularity in the rest of the world. The cornerstone in oncoplastic breast surgery is to respect oncological principles during cancer resection maintaining good aesthetic and cosmetic outcome. With the advancement in local, regional, and systemic treatment for breast cancer, survival has improved, and patients live longer. It is utmost essential to help our patients to maintain a good quality of life. Aesthetic and cosmetic outcomes have a significant impact on patient's psychosocial, emotional, and sexual well-being.Oncoplastic techniques have evolved over the last decade with the increasing use of perforator flaps to enable partial breast reconstruction. We report the findings of a prospective cohort study using modified lateral intercostal artery perforator in partial breast reconstruction. This modified technique offers a less visible scar and good access to the axilla without any need for repositioning the patient during the operative procedure. METHODS A retrospective review of a prospectively maintained database of patients who underwent partial breast reconstruction with a modified lateral intercostal artery perforator flap was carried out between July 2016 and January 2020 in 2 oncoplastic breast units. The study had local approval from the respective audit departments. Patient demographics, operative data, surgical complications, and outcomes were collected and analyzed. RESULTS Forty-one patients underwent the procedure between July 2016 and January 2020. The median age of the population data was 58 years (interquartile range, 9 years). There were 10 active smokers (24.4%), and 3 patients had diabetes mellitus (7.3%). Overall, 3 patients (7.1%) developed seroma, 1 had a hematoma (2.4%), and 1 had a locoregional recurrence (2.4%). Two patients (4.9%) underwent margin re-excision for close margins. Most patients (92%) had the procedure carried out as day-case surgery. None of the patients developed wound infection, necrosis, or flap loss. The results were comparable across the 2 participating units. CONCLUSIONS The data suggest that modified intercostal artery perforator flap is an excellent oncoplastic technique for volume replacement in partial breast reconstruction with a short learning curve and minimal perioperative morbidity.
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Affiliation(s)
| | - Dinesh Thekkinkattil
- Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom
| | | | - Lydia Prusty
- Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom
| | - Raghavan Vidya
- From the The Royal Wolverhampton NHS Trust, Wolverhampton
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17
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Abstract
Breast reconstruction is nowadays a component of surgical treatment of breast cancer; therefore plastic surgeons are widely involved in breast reconstruction procedures either after mastectomy or after wide quadrantectomy. The aim is to reduce the distortion of breast shape and to improve the aesthetic outcome of the oncological procedure taking in account the symmetric appearance of the breasts. In post quadrantectomy reconstruction, breast reshaping with mammoplasty pattern could be applied in large and ptotic breast; otherwise flaps from lateral thoracic area could be used as well in post mastectomy reconstruction. In the case of mastectomy, the mastectomy procedure itself has become increasingly conservative, thus allowing an improvement in the aesthetic results of the reconstruction, especially if an implant is used. If adequate thickness of the mastectomy flap is preserved, the prosthesis can be placed in front of the muscle (prepectoral reconstruction), rather than behind the muscle (submuscular reconstruction). In prepectoral reconstruction the postoperative recovery is easier and less distressing for the patient and the postoperative appearance is more natural then in submuscular reconstruction. Autologous breast reconstruction implies the use of flaps (tissue taken from donor areas and used to reconstruct the breast area after appropriate molding), this technique allows to obtain a natural appearance of the breast with similar characteristics to the original one, and can be used in the radiated field. Different options of flaps include flaps from back area (local flaps) and flaps from distant areas (free flaps), basically from abdomen and inner tight.
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Affiliation(s)
- Marzia Salgarello
- Department of Plastic and Reconstructive Surgery, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giuseppe Visconti
- Department of Plastic and Reconstructive Surgery, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Liliana Barone-Adesi
- Department of Plastic and Reconstructive Surgery, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
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18
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Hourston G, Joglekar S, Down S, Downey S, Pereira J. Has the time come for de-escalation in oncoplastic breast conserving surgery? Eur J Surg Oncol 2021; 48:309-311. [PMID: 34740479 DOI: 10.1016/j.ejso.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- George Hourston
- Breast Care Unit, James Paget University Hospitals NHS Foundation Trust, United Kingdom.
| | - Sandeep Joglekar
- Breast Care Unit, James Paget University Hospitals NHS Foundation Trust, United Kingdom
| | - Sue Down
- Breast Care Unit, James Paget University Hospitals NHS Foundation Trust, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom
| | - Sarah Downey
- Breast Care Unit, James Paget University Hospitals NHS Foundation Trust, United Kingdom
| | - Jerome Pereira
- Breast Care Unit, James Paget University Hospitals NHS Foundation Trust, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom
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19
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Jacobs JED, Al Shaer S, Schmidbauer U, de Leeuw DM, Rakhorst HA, Zöphel OT. The anterior LICAP flap: a design option for oncoplastic breast reconstruction. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:158-163. [PMID: 34621915 PMCID: PMC8491666 DOI: 10.1080/23320885.2021.1986048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose was to describe the operation technique of an anterior lateral intercostal artery perforator (LICAP) flap and analyse outcomes and complications. An anterior LICAP flap is a good and safe alternative for direct oncoplastic breast reconstruction. It is a reliable flap that provides sufficient volume and good esthetic outcomes.
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Affiliation(s)
- Juliëtte E D Jacobs
- Department of Plastic, Reconstructive and Handsurgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
| | - Sanharib Al Shaer
- Department of Surgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
| | - Ute Schmidbauer
- Department of Plastic, Reconstructive and Handsurgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
| | - Daniëlle M de Leeuw
- Department of Surgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
| | - Hinne A Rakhorst
- Department of Plastic, Reconstructive and Handsurgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
| | - Oliver T Zöphel
- Department of Plastic, Reconstructive and Handsurgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
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20
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Pujji OJS, Blackhall V, Romics L, Vidya R. Systematic review of partial breast reconstruction with pedicled perforator artery flaps: Clinical, oncological and cosmetic outcomes. Eur J Surg Oncol 2021; 47:1883-1890. [PMID: 33895022 DOI: 10.1016/j.ejso.2021.03.249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/12/2021] [Accepted: 03/23/2021] [Indexed: 11/20/2022] Open
Abstract
The use of chest wall perforator flaps (CWPFs) following breast conservation surgery for breast cancer has become a useful tool in the armamentarium of the oncoplastic breast surgeon, however robust evidence for the technique is lacking. The aim of this study was to conduct a systematic review appraising the current evidence for the use of CWPFs, evaluating clinical, oncological and cosmetic outcomes. A PRISMA-compliant systematic review, with PROSPERO published protocol a priori and search of all relevant database and trial registries between 1990 to July 2020. Eleven studies amounting to 432 cases were reviewed and considered to be at high risk of bias due to small sample size, selective outcome reporting and selection bias. Heterogeneity due to lack of consensus of outcome measures prevented meaningful analysis. Fifty-two (12.3%) clinical complications were recorded: seroma (n = 9; 2.1%), fat necrosis (n = 9; 2.4%), haematoma (n = 8; 1.9%), infection (n = 9; 2.1%), and flap necrosis (n = 9; 2.1%). Thirty-four (10.8%) patients had an involved positive margin, 29 patients underwent re-excision (9.3%) and four underwent completion mastectomy (1.3%). One local recurrence and six distant recurrences were observed during a mean follow up of 21 months (1-49). A pooled patient cosmetic satisfaction descriptor of good or excellent was described in 93% of cases. CWPFs are a safe method of partial breast reconstruction following BCS. They are associated with a low complication rate, acceptable short-term oncological outcomes and satisfactory cosmetic outcome. There is a relative paucity in quality of data in this field and larger prospective studies are needed to investigate outcomes further.
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Affiliation(s)
- O J S Pujji
- Academic Foundation Trainee, The Royal Wolverhampton NHS Trust, England, UK.
| | - V Blackhall
- General and Oncoplastic Breast Surgery Registrar, Gartnavel General Hospital, Greater Glasgow and Clyde, NHS Scotland, UK
| | - L Romics
- Consultant Oncoplastic Breast Surgeon, New Victoria Hospital, Greater Glasgow and Clyde, Scotland, UK
| | - R Vidya
- Honorary Senior Lecturer, Birmingham University, Consultant Oncoplastic Surgeon, The Royal Wolverhampton NHS Trust, England, UK
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21
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Breast Reconstruction Using the Lateral Thoracic, Thoracodorsal, and Intercostal Arteries Perforator Flaps. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3334. [PMID: 33564575 PMCID: PMC7858286 DOI: 10.1097/gox.0000000000003334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/20/2020] [Indexed: 12/02/2022]
Abstract
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.
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22
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An evaluation of patient reported outcomes by utilizing breast Q following oncoplastic breast conserving surgery and arc-LICAP flap partial breast reconstruction. J Plast Reconstr Aesthet Surg 2020; 74:1101-1160. [PMID: 33218964 DOI: 10.1016/j.bjps.2020.10.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022]
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