Autologous breast augmentation with the lateral intercostal artery perforator flap in massive weight loss patients

The body contour deformities that develop in morbidly obese patients following bariatric surgery often involve the breasts. Mastopexy is virtually always required in the female massive weight loss patient, and breast augmentation is often an important adjunct to breast-lifting procedures. The lateral intercostal artery perforator (LICAP) pedicled flap provides ample material for autogenous breast augmentation in such patients. Between June 2001 and June 2005, bilateral LICAP flaps were used as a method of autologous breast augmentation in six patients after massive weight loss. Of the 12 pedicled LICAP flaps raised, the average flap dimension was 23.6x10.6 cm. Mean flap harvesting time was 60 min (range 45-75 min) for a single flap. All but two flaps were based on one perforator. All donor sites were closed primarily. Complete flap survival was achieved in all cases. A minor wound dehiscence occurred in two cases both of which healed secondarily. Patient satisfaction with both the appearance of their breasts and lateral axillary-thoracic region was high. The improved contour of the lateral axillary region was frequently noted as a significant benefit. In massive weight loss patients, harvesting the lateral skin-fat excess based on the LICAP provides supple tissue for breast augmentation, while simultaneously improving the contour of this area frequently affected by skin excess. Additionally, harvesting these flaps without sacrifice of the underlying muscle eases postoperative recovery and reduces donor site morbidity.