Mapping lateral chest wall perforators: A cadaveric study on anatomical details for oncoplastic breast surgery

Breast-conserving surgery is the standard treatment for early-stage breast cancer. Lateral chest wall perforator flaps (LCWPFs) provide effective volume replacement reconstruction that can preserve the latissimus dorsi (LD) muscle and minimize scarring. These region-based perforators include the lateral intercostal arterial perforators (LICAPs), lateral thoracic artery perforators (LTAPs), and septocutaneous thoracodorsal arterial perforators (sc-TDAPs). We examined the anatomical details of LCWPs in Thai cadavers, highlighting their clinical applications in oncoplastic breast surgery.

Colored silicone injections were introduced into the internal mammary and brachial arteries of 12 non-formaldehyde-preserved female cadavers. Suprafascial dissection was performed in the lateral decubitus position to identify perforators and their anatomical landmarks.

A total of 120 perforators were identified, with a mean of 5 perforators per side. LTAPs were present in 96.8% of the sides, with 82.6% having a single perforator. LTAPs predominantly occurred in the 3rd intercostal space (53.6%), at a mean distance of 2.1 cm from the LD muscle. The lateral thoracic artery (LTA) originated from the axillary artery (90.5%), averaging 8.9 cm in length to the first perforator; LICAPs were mostly found at the 4th to 7th intercostal spaces and were located 2.2 cm from the LD muscle, whereas sc-TDAPs (16.67%) were present in the lateral chest wall region.

Our findings demonstrated the reliability of LCWPs, especially in the 3rd to 7th intercostal spaces. The length of LTA could be advantageous for distant flap movement in the reconstruction of inner breast defects. LCWPs for LCWPFs were reliable in all patients who underwent oncoplastic breast surgery especially when 2 consecutive intercostal spaces were included.