Lateral perforator flap: A surgically and oncologically safe method for patients with breast cancer

Chestwall perforator flaps have been used in breast conservation after wide local excision for more than a decade. Although the technique is promising, it still needs to be standardized. For example, no published studies have numerically proven that the operated breast retains its features after operation and radiation. This study compared preoperative- and 1-year postoperative measurements to investigate whether there are any significant changes to the breast.

The study examined all patients with breast cancer who were operated on with a lateral chest wall perforator flap in a primary setting between the years 2011 and 2021 at the surgical department of Kristianstad Central Hospital. Volume, ptosis, and the sternal notch-nipple distance were measured by the clinician, and standardized photos were analysed with BCCT.core software to determine the cosmetic outcome. A Likert scale of 1-10 was used to subjectively measure cosmetic outcomes.

139 patients diagnosed with breast cancer or DCIS were operated on with breast-conserving surgery and a lateral perforator flap during the study period. For statistical analysis the untreated breast served as the patient's own control. No difference was found in regard to volume, but the sternal notch-nipple distance and ptosis decreased slightly but significantly by 6 and 5 mm,resepectively (p < 0.001). BCCT.core classified the postoperative results as 80% excellent or good, while the preoperative rate was 89%.

This study shows that lateral chest wall perforator flaps are a surgically and oncologically safe technique that conserves common features of the breast according to measurements before and 1 year after operation and radiotherapy.