Local Flaps in Breast-Conserving Surgery in Early Breast Cancer Patients: Armamentarium for Breast Surgeon

Abstract

To describe the technique and outcome of local perforator arteries advancement flap in breast-conserving surgeries (BCS) in patient of early breast cancer as our initial experience and review of literature on it. Patients who underwent (BCS) with local perforator artery flap reconstruction were reviewed in terms of their clinical, surgical, and post-operative follow-up details after taking written and informed consent. We have described 4 patients of early breast cancer out of which one patient was post-NACT while 3 were for upfront BCS. We have performed LICAP in 2 patients, AICAP in 1 patient, and IMAP in one patient, depending on the location of primary tumors. None of the patients had any major or minor surgical complications in the post-operative period and drains were removed on post-operative day 2. All patients received post-operative radiotherapy and tolerated well without any loco-regional complications. Patients are in routine follow-up with cosmetic satisfaction without any local recurrence over 1 year. The main advantages of pedicled perforator flaps are well-vascularized tissue, spares underlying muscle leading to lesser donor site morbidity like muscle function and seroma formation, easily reach the breast area with good match in terms of skin and subcutaneous tissue, faster recovery, and shorter learning curve in comparison to free flaps. Knowledge and skill about these flaps will help surgeon to give better surgical outcomes and satisfaction to patients.

Keywords: Armamentarium; Breast surgeon; Breast-conserving surgery.

Fig. 1

44/F Ca left breast cT2NoMo with tumor in central quadrant A pre-op picture, B specimen of wide local excision, C marking for flap and SLNB, D mobilized LICAP flap, E approximation of flap into defect, F POD2 clinical picture, G clinical picture at 1 year of follow-up post-radiotherapy

Fig. 2

62/F Ca right breast cT2NoMo with tumor in upper central quadrant A pre-op picture, B marking of incision for SLNB, flap, and WLE; C incision and mobilization of flap, D approximation of LICAP flap into defect, F POD2 clinical picture, G clinical picture at 1 year of follow-up post-radiotherapy

Fig. 3

66/F case of carcinoma right breast cT2NOMO showing A intraoperative picture of mobilized flap, B excised tumor, C and D post-operative day 20 pictures with completely healed wound and symmetric looking breast

Fig. 4

47/F Ca right breast ycT2NoMo with tumor into upper inner quadrant A preoperative clinical picture, B & C on table incision marking for wide local excision of tumor and flap reconstruction, D specimen of wide local excision of tumor, E intra-op picture of mobilized IMAP flap, F & G POD2 clinical pictures, H clinical picture on follow-up at 6 weeks