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The Intercostal Artery Perforator Flap: Expanding Breast-Conserving Therapy With a Modified Oncoplastic Approach
Garrison A Leach1, Robert C Clark1, Solomon Tong1
1From the Division of Plastic Surgery, Department of General Surgery.
Annals of Plastic Surgery
|February 8, 2023
Summary
Intercostal artery perforator (ICAP) flaps enable expanded breast conservation therapy, reducing the need for mastectomy. ICAP flap reconstruction offers improved patient outcomes, including fewer complications and less opioid use compared to traditional methods.
Area of Science:
- Plastic Surgery
- Oncologic Surgery
- Reconstructive Surgery
Background:
- Breast-conserving surgery is limited by significant oncologic deformity or radiotherapy intolerance.
- Mastectomy is often required for extensive defects.
- Upper abdominal wall tissue flaps offer an alternative for breast conservation.
Purpose of the Study:
- To describe the expanded use of intercostal artery perforator (ICAP) flaps for breast reconstruction.
- To detail the ease of adoption of the ICAP flap technique.
- To compare ICAP flap outcomes with standard alloplastic reconstruction.
Main Methods:
- Retrospective review of patients undergoing ICAP flaps for partial mastectomy defects.
- Comparison of ICAP flap outcomes with unilateral tissue expander (TE) reconstruction.
- Data collection included demographics, intraoperative details, and postoperative outcomes.
Main Results:
- Twenty-seven patients received ICAP flaps; 27 had TE reconstruction.
- ICAP flaps had longer plastic-specific operative times but similar total operative times.
- TE patients experienced longer hospital stays and more major complications, with higher opioid refill rates.
Conclusions:
- ICAP flaps expand breast conservation indications for large or complex defects.
- This technique is adoptable and relatively simple to implement.
- ICAP flap reconstruction may lead to better outcomes than mastectomy, with reduced opioid requirements and hospital stays.
