Pedicled local flaps: a reliable reconstructive tool for partial breast defects

Breast conserving surgery (BCS) followed by radiotherapy has gained great popularity in the treatment of breast cancer over the past years. However, radiation therapy can lead to many unfavourable aesthetic outcomes including significant volume/skin deficiency, nipple areola complex distortion and skin contraction. We present our experience in using pedicled perforator flaps to tackle the resultant partial breast defects or deformities.

A retrospective data analysis study on Thirty patients with post breast conserving surgery (BCS) partial breast defects who were managed with pedicled per-forator flaps including muscle sparing latissimus dorsi muscle flap (MSLD), thoraco-dorsal artery perforator flap (TDAP) and intercostal artery perforator flap (ICAP) in the period between December 2008 and December 2018.

Defects were in all quadrants apart from the upper inner quadrant. The reconstructive techniques included TDAP flap 6/30 (20%), MSLD flap 20/30 (66.7%), AICAP flap 4/30 (13.3%). Age ranges 22-35 (mean 29). All flaps showed complete survival, one nipple areola complex superficial epidermolysis was experienced, and one patient presented with fat necrosis. No resultant donor site morbidity apart from scar revision for excess skin at the axillary fold in one patient. The overall satisfaction reached 94% with only 8 patients who required lipofilling to maximize the cosmetic outcome.

The availability of a range of reliable techniques including thoracodorsal/intercostal artery perforator flap (TAP/ICAP) and muscle sparing lattissimus dorsi flap (MSLD) allow optimum results to be achieved in the treatment of partial breast defects following breast conserving surgery.