ABSTRACT
Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a
versatile tissue replacement technique for partial breast reconstruction
following breast-conserving surgery (BCS) in well-selected cases. We present
the surgical outcome of 81 patients with chest wall perforator flaps used for
breast-conserving surgery. Methods: We recorded the outcomes of three
oncoplastic breast surgeons who performed partial breast reconstruction with
chest wall perforator flaps from 1st January 2018 to 30th June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were
collected on patient demographics, including age, BMI, smoking status, bra
size, previous treatments, type of CWPF procedure, tumor size (measured
clinically, via imaging and histologically), biopsy results, specimen weight,
margins involvement, re-operation rate, surgical site infection (SSI), flap
loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81
patients were included in this study, with an average age of 55.7 years and a
body mass index (BMI) of 26.7 kg/m2.
The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D
(13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant
chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery
perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP
(medial intercostal artery perforator), and for seven patients, LTAP (lateral
thoracic artery perforator) flaps were used. The average tumor was measured at
15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy
showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were
invasive. 16% of patients had involved margins, and re-excision was required in
10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%,
with flap-related complications, including flap loss and shrinkage, at 3.7% and
4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other
complications. Conclusion: Partial breast reconstruction with perforator
flaps is an excellent volume replacement technique in breast-conserving surgery
with acceptable complications in well-selected cases.