Patient-reported BREAST-Q Outcomes of Chest Wall Perforator Flaps in Partial Breast Reconstruction: A Single-center...

Chest wall perforator flap (CWPF) reconstruction is becoming increasingly used in oncoplastic breast-conserving surgery. It enables tissue replacement after large tumor resections in single-stage operations without symmetrization surgery, all while achieving adequate margins to avoid mastectomy. Literature on BREAST-Q outcomes for CWPFs remains scarce. This study details our institutions' experience with CWPFs and evaluates their health-related quality of life outcomes.

Forty patients underwent CWPF reconstruction at our institution between February 2022 and November 2024. Patient demographics, tumor characteristics, surgical factors, and complications were collected through retrospective chart review. The reconstruction module of the BREAST-Q questionnaire assessed postoperative patient-reported outcomes, with a response rate of 78% (n = 31).

The most common flaps were based on the lateral intercostal artery perforators (70.0%, n = 28), medial/anterior intercostal artery perforators (25.0%, n = 10), and lateral thoracic artery perforators (5.0%, n = 2). Margin re-excision and conversion to mastectomy rates were 23.1% (n = 9) and 10.3% (n = 4), respectively. Postoperative events needing intervention (seroma and complications) were associated with diabetes mellitus (P = 0.02). The median scores for BREAST-Q domains were as follows: 71.0 (satisfaction with breasts), 80.0 (physical well-being: chest), 83.0 (psychosocial well-being), 62.0 (sexual well-being), and 69.0 (breast sensation).

Our findings suggest that CWPF reconstruction is well tolerated and achieves postoperative satisfaction rates and health-related quality of life outcomes comparable to other forms of oncoplastic breast-conserving surgery. Longitudinal studies with greater statistical power are needed to reliably assess predictors of breast satisfaction and postoperative morbidity.