Role of chest wall perforator flaps in reconstruction of upper inner breast defects

Breast-conserving surgery (BCS) is the standard treatment for early-stage breast cancer; however, defects in the upper inner quadrant (UIQ) remain a significant reconstructive challenge due to paucity of local tissue and heightened cosmetic sensitivity of this quadrant. Chest wall perforator flaps (CWPFs) have emerged as a reliable volume replacement option with minimal donor-site morbidity, yet data focusing specifically on their use in UIQ defects are limited.

This retrospective study included 20 female patients with UIQ breast tumors who underwent partial breast reconstruction using CWPFs between January 2022 and December 2023. Data regarding patient and tumor characteristics, flap type, operative details, and postoperative complications were collected. Aesthetic outcomes were objectively assessed using BCCT.core software (version 3.1), while patient-reported outcome measures (PROMs) were evaluated at 12 months postoperatively using the BREAST-Q questionnaire.

The mean patient age was 40.7 ± 5.0 years. The most commonly used flap was the anterior intercostal artery perforator (AICAP) flap (40%), followed by combined LICAP/LTAP flaps (25%). The mean operative time was 79.0 ± 7.5 min. Postoperative complications occurred in 20% of patients, including seroma (10%), wound infection (5%), and fat necrosis (5%), with no cases of major flap loss or positive surgical margins. According to BCCT assessment, excellent and good cosmetic outcomes were achieved in 95% of patients. PROMs demonstrated favorable outcomes, with mean scores of 73.4 ± 4.7 for physical well-being, 73.8 ± 4.2 for psychological well-being, and 70.1 ± 6.3 for satisfaction with the breast.

CWPFs were used for reconstruction of UIQ defects following breast-conserving surgery with acceptable postoperative complication rates and favorable cosmetic assessment in this retrospective cohort. These findings describe the surgical and aesthetic outcomes observed in this challenging breast quadrant. Further prospective studies with larger patient populations are needed to better define the role of CWPFs in UIQ reconstruction.

Retrospectively registered after the approval of Baheya Ethical Committee, IRB no. 202,506,300,026.