Extended applications of chest wall perforator flaps in breast surgery: case series and systematic literature review

Chest wall perforator flaps (CWPFs) are integral to modern oncoplastic breast surgery, offering volume replacement without muscle sacrifice. While their role in partial breast reconstruction is established, data on extended and non-conventional applications remain limited. This study aims to synthesize current clinical experience and delineate the extended applications of chest wall perforator flaps beyond conventional oncoplastic contexts.

This study combined a prospective institutional case series from two tertiary centers (Singapore and UK) with a systematic literature review of PubMed, Embase, Web of Science, and Cochrane databases. Eligible studies described CWPF use for extended oncologic, reconstructive, or aesthetic indications. Data were synthesized descriptively according to PRISMA guidelines.

Six women underwent LICAP-based reconstruction for complex indications including skin-replacing excisions, implant salvage, chronic sinus closure, and total autologous reconstruction with adjunct lipofilling. All flaps were fully viable with good contour restoration and symmetry, and adjuvant therapy proceeded without delay. The systematic review identified 38 studies (≈ 324 patients, 349 flaps). CWPFs, most commonly LICAP, LTAP, and TDAP, were used for defects following oncologic resection, radiotherapy injury, implant failure, or post-bariatric contour correction. Overall flap success exceeded 95%, with major complications under 5%. Donor-site morbidity was minimal, with high aesthetic satisfaction (> 90%).

CWPFs represent muscle-sparing reconstructive options whose utility may extend beyond conventional oncoplastic indications; this descriptive series supports their feasibility and short-term outcomes across a range of selected clinical settings, suggesting that CWPFs warrant further consideration in the management of complex breast and chest wall defects.