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. 2019 Feb 5;7(2):e2066.
doi: 10.1097/GOX.0000000000002066. eCollection 2019 Feb.

The Modified Lateral Intercostal Artery Perforator Flap

Farid Meybodi  1 , Annelise M Cocco  1 , David Messer  1 , Alexander Brown  1 , Kavitha Kanesalingam  1 , Elisabeth Elder  1 , Jeremy Hsu  1 , James French  1
Affiliations

The Modified Lateral Intercostal Artery Perforator Flap

Farid Meybodi et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: The main surgical options for treatment of breast cancer are breast-conserving surgery and mastectomy. BCS aims to achieve complete excision of the tumor while achieving a pleasing cosmetic result. Excision of tumors in the lateral aspect of the breast has been associated with issues such as contour deformities and asymmetry. Development of volume replacement techniques such as the lateral intercostal artery perforator flap (LICAP) aimed to address these issues. Our modification of the traditional LICAP offers a less visible scar, good access to the axilla, and no need to reposition the patient.

Methods: All patients undergoing a modified LICAP were identified from our database. The lateral intercostal artery perforators were marked with ultrasound and 2 "lazy S" lines were drawn to mark the flap. The wide local excision (with or without axillary surgery) was performed and the flap mobilized to fill the defect.

Results: Twenty-two patients underwent modified LICAP in 14 months. The mean specimen weight was 86 g. Four patients (18%) had a re-excision for positive margins. Nineteen patients had axillary surgery performed at the time of their modified LICAP flap. No patients had a scar that extended posterior to the posterior axillary line; no patients required a separate incision for axillary surgery; and no patients needed to be repositioned intraoperatively.

Conclusions: Our early experience with this innovative procedure has been favorable. The perioperative complication rate is low. Due to the relatively short follow-up, longer term outcomes such as postradiotherapy appearance are yet to be determined.

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Figures

Fig. 1.
Fig. 1.
The original LICAP flap.
Fig. 2.
Fig. 2.
The progression in a modified LICAP flap.
Video Graphic 1.
Video Graphic 1.
See video, Supplemental Digital Content 1, which displays the modified lateral intercostal artery perforator flap. This video is available in the “Related Videos” section of the Full-Text article at PRSGlobalOpen.com or at http://links.lww.com/PRSGO/B32.
Fig. 3.
Fig. 3.
Preopetrative photographs, 25 mm invasive ductal carcinoma at right breast 9 o’clock.
Fig. 4.
Fig. 4.
Photographs 6 months post wide local excision and sentinel node biopsy (specimen weight 61 gr).
See this image and copyright information in PMC

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