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The Modified Lateral Intercostal Artery Perforator Flap

Meybodi, Farid, MD, MS, FRACS; Cocco, Annelise M., BA, MBBS; Messer, David, MBBS, FRACS; Brown, Alexander, MBChB, FRCS; Kanesalingam, Kavitha, MBChB, MRes, FRCS; Elder, Elisabeth, PhD, FRACS; Hsu, Jeremy, MBBS, FRACS; French, James, MBBS, FRACS

Plastic and Reconstructive Surgery – Global Open: February 5, 2019 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000002066
Latest Articles: PDF Only

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.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the estmead Breast Cancer Institute, Westmead Hospital; and University of Sydney.

Published online 5 February 2019.

Received for publication August 25, 2017; accepted October 10, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

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Farid Meybodi, MD, MS, FRACS, Westmead Hospital, E-mail:

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.