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Immediate Breast Reconstruction with Fat-Graft-Augmented ICAP Flaps
Francesco Klinger1, Mattia Federico Cavallero2,3, Andrea Vittorio Emanuele Lisa2,4,5
1Department of Health Sciences, Ospedale San Paolo, University of Milan, via Antonio di Rudinì 8, 20142 Milan, Italy.
Life (Basel, Switzerland)
|July 29, 2025
Summary
Combining intercostal artery perforator (ICAP) flaps with autologous fat grafting offers a viable solution for breast-conserving surgery (BCS) reconstruction. This technique enhances volume and aesthetics with low complication rates, though smoking impacts outcomes.
Area of Science:
- Plastic Surgery
- Oncologic Surgery
- Reconstructive Surgery
Background:
- Intercostal artery perforator (ICAP) flaps are effective for breast-conserving surgery (BCS) volume replacement, especially for lower pole defects.
- Limited ICAP flap volume can restrict their use in some patients.
- Autologous fat grafting is explored to improve volume and aesthetic results in BCS reconstruction.
Purpose of the Study:
- To evaluate the feasibility and outcomes of fat-graft-augmented ICAP flaps for immediate breast reconstruction after BCS.
- To assess flap viability, complication rates, and aesthetic results of this combined technique.
Main Methods:
- Retrospective study of 10 patients undergoing BCS with immediate reconstruction.
- Utilized nine anterior ICAP (AICAP) flaps and one lateral ICAP (LICAP) flap.
- Augmented ICAP flaps with 20-60 cc of autologous fat grafting, followed for 6 months.
Main Results:
- Partial flap resorption occurred in 20% of patients, both active smokers.
- No skin necrosis was observed.
- Satisfactory aesthetic outcomes with good breast contour restoration and stable flap/fat integration.
Conclusions:
- Combined ICAP flaps and autologous fat grafting represent a feasible and effective method for immediate BCS reconstruction.
- This technique enhances volume, maintains natural contour, and has low complication rates in selected patients.
- Active smoking is identified as a significant risk factor for adverse outcomes.
