Chest wall perforator flaps for partial breast reconstruction: Surgical outcomes from a multicenter study

Abstract

Background: Perforator artery flaps based on the branches of intercostal arteries and lateral thoracic artery can be used for reconstruction after breast-conserving surgery (BCS). Although described more than a decade ago, these have not been adopted widely in clinical practice. We report on short-term and long-term surgical outcomes of partial breast reconstruction using chest wall perforator flaps from a prospective multicenter audit.

Methods: All patients operated for BCS and partial breast reconstruction using intercostal artery perforator or lateral thoracic artery perforator flaps from January 2015 to October 2018 were included in the analysis. Oncoplastic breast surgeons with appropriate level of training performed all tumor excisions and reconstructions as a single-stage procedure. Patient characteristics, treatment details and surgical outcomes were noted. Specific outcomes recorded were margin re-excision and complication rates.

Results: One hundred and twelve patients underwent the procedure in the given study period. The median age was 54 years. Median specimen weight was 62.5 g and median volume of excision was 121.4 mL. Fifteen patients (13.39%) underwent a margin re-excision for close or positive margins without additional morbidity. One patient required a completion mastectomy. Eight patients (7.14%) had an early complication. None of the patients required a contralateral symmetrization procedure. The results were comparable across the participating centers.

Conclusions: Chest wall artery perforator-based flaps are an excellent option for lateral and inferior quadrant partial breast reconstructions. The short and long-term surgical outcomes are comparable across sites and can be performed with minimal morbidity. Patient-reported outcome measures need to be studied.

Keywords: Breast neoplasms; Perforator flap; Surgical flaps.

Fig. 1.. Flap markings for reconstruction

For lateral intercostal artery flap (A) and anterior intercostal artery-based flaps (B).

Fig. 2.. Surgical outcomes

Preoperative (A, B) and 3 months postoperative (C, D) outcomes after a lateral intercostal artery perforator flap reconstruction.

Fig. 3.. Comparative outcomes across participating centers

Comparison of 24-hour discharge rates, margin re-excision rates and complication rates across the participating centers. ^a)Center C includes patients from two centers as the same surgeon operated across both centers.