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Lateral Intercostal Artery Perforator Flap: A Single Surgeon Experience and Review of the Literature for Partial Breast Reconstruction

Bram, Ryan MD; Johnson, Chelsey MD; De La Cruz, Carolyn MD; MacIsaac, Zoe Marie MD; Gimbel, Michael MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 21
doi: 10.1097/01.GOX.0000584308.53122.35
Breast Abstracts
Open

Tripler Army Medical Center, Medical Center, Honolulu, HI

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.

BACKGROUND: In 1979, Kerrigan et al described the anatomical locations and potential reconstructive use of the different perforating branches of the intercostal artery. Later, in 1986, Holmstrom et al reported a flap based off the lateral perforating branch of the intercostal artery—the lateral intercostal artery perforator (LICAP) flap—as an option for superolateral breast reconstruction. Since that time, the LICAP flap has been described in cases reports, retrospective reviews, and even a prospective trial. However, a review of the literature has yet to be published. The purpose of this study was to review our institution’s experience and perform a review of the literature.

METHODS: A retrospective review was conducted of a single surgeon’s experience at a major university center. Patients who underwent LICAP flaps between the years of 2007 and 2018 were included. Pre- and postoperative photographs were reviewed, patient demographics were analyzed, and complication rates were determined. A review of the literature was performed on PubMed with search terms “lateral intercostal artery perforator flap” and “lateral thoracodorsal flap,” selecting for articles describing the use of this flap for partial breast reconstruction.

RESULTS: Eleven total patients underwent lateral perforator flaps for reconstruction of segmental mastectomy. Average age was 55 years old. Diagnosis at the time of breast conserving surgery included ductal carcinoma in situ and invasive carcinoma and chronic wound subsequent to radiation therapy. Total excision volume ranged from 3 × 4 × 2 cm to 6 × 6 × 5 cm, from the superolateral breast. The majority of reconstructions were performed in a delayed fashion. No seromas, no delayed healing, nor any need for operative revision were reported. From our literature search, 137 total articles were initially identified. Of these, 38 included information on 1,453 patients who underwent 1,528 laterally based perforator flaps for partial breast reconstruction. Patient age ranged from 23 to 83 years old, with an average reported specimen weight of 160 g and flap dimensions of 15.7 × 6.9 cm. Overall complication rate was low with most complications classified as minor and not requiring surgical intervention. Major complication leading to surgical revision was seen in only 2.57% of flaps. Donor site complications were not common, with seroma the most frequent seen in 3.5% of cases. Diabetes mellitus, thyroid disease, pulmonary and cardiovascular disorders, flap length over 17 cm, smoking, high body mass index, and history of radiation were significantly associated with complications. Additionally, several studies reported good to excellent esthetic outcomes using verified surveys such as SF-36 and the BREAST-Q, and independent review by other plastic surgeons.

CONCLUSION: The LICAP flap presents a robust option for reconstruction of superolateral partial mastectomy defects. It may be performed in a delayed fashion to ensure negative margins at the time of reconstruction and achieves good esthetic outcomes with low risk of complications.

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