No-Doppler Medial Intercostal Artery Perforator Flap for Partial Breast Reconstruction: Surgical Technique,...

Breast-conserving surgery (BCS) for tumors in the inner quadrants and nipple-areolar complex presents a significant challenge due to the inherent lack of volume in these breast regions. This makes it difficult to achieve satisfactory cosmetic outcomes using oncoplastic volume displacement techniques. The medial intercostal artery perforator (MICAP) flap offers an effective solution for volume replacement in cancers located in areas with depleted volume. This study highlighted the surgical technique, feasibility, and postoperative outcomes associated with MICAP flap reconstruction. We analyzed data from a prospectively maintained, structured, computerized, comprehensive database of 42 patients who underwent partial breast reconstruction using MICAP flaps after January 2022 and completed one year of follow-up before April 2025. All MICAP flaps were harvested by surface marking anatomical landmarks without a handheld Doppler. Data on demographics, perioperative events, and surgical outcomes were recorded. Patient satisfaction was evaluated using the BREAST-Q questionnaire, specifically the Breast Conserving Therapy (BCT) module, at 6 months after completion of radiotherapy. Forty-two patients underwent MICAP flap reconstruction after BCS, with a median age of 50 years (IQR 42-58). Most had small-to-medium-sized breasts (A and B cup, 81%) and no ptosis (83.3%). Tumors were mainly in the lower inner quadrant (73.8%). Median flap dimensions were 11 × 5 cm, with an operative time of 23 min (IQR 20-25) and blood loss of 10 mL (IQR 5-15). Postoperative complications occurred in six patients (14.3%), all minor, while three patients (7.1%) had positive margins requiring re-excision. Adjuvant radiotherapy began at a median of 5 weeks postoperatively (IQR 4-6), with 39 patients completing treatment as scheduled. At a median follow-up of 12 months, no local recurrences were documented. Patient-reported outcomes using the BREAST-Q questionnaire showed no significant changes in satisfaction, psychosocial, sexual, or physical well-being domains (p > 0.05), indicating preserved quality of life after MICAP flap reconstruction. The MICAP flap is a robust volume replacement technique for inner and central breast quadrants, allowing safe oncological wide local excision with minimal complications. Knowledge of perforators and anatomical landmarks aids in harvesting these flaps. This technique provides equivalent breast-related quality of life compared to preoperative values, reduces the mastectomy rate, and the need for contralateral symmetrization.