The IMAP and MICAP Flaps for Autologous Breast Reconstruction: An Anatomic, Clinical, and Outcome Study

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Local flaps are emerging as a practical alternative to remote flaps in breast reconstruction.
• Understanding perforator flap anatomy is crucial for successful breast reconstruction.

Purpose of the Study:

• To detail the anatomy of internal mammary artery perforators and lateral intercostal artery perforator flaps.
• To evaluate the clinical outcomes and patient satisfaction associated with these perforator flaps for breast reconstruction.

Main Methods:

• Cadaveric dissection of medial perforators from the fifth intercostal space.
• Breast reconstruction using internal mammary artery perforator flaps in 22 patients, with 4 cases combined with lateral intercostal artery perforator flaps.
• Clinical evaluation and statistical analysis of outcomes, including patient satisfaction on a 5-point Likert scale.

Main Results:

• All flaps achieved successful survival with no instances of partial flap necrosis.
• No major complications like total flap loss or partial necrosis were observed; two cases of fat necrosis occurred.
• High patient satisfaction reported: 100% excellent/very good when clothed, 93.3% good/very good when unclothed.

Conclusions:

• Submammary perforator flaps can be reliably raised using various vascular pedicles.
• Internal mammary and lateral intercostal perforators are effective for partial or total breast reconstruction in selected patients.