Relocating the defect: A technical refinement to reduce boost-field exposure and extend reach in chest wall perforator flap reconstruction

Chest wall perforator flaps (CWPFs) extend breast conservation options, however medial and upper-inner-quadrant defects lie far from the standard donor sites, demanding a long arc of rotation or aggressive perforator skeletonisation. Additionally, because the flap is inset into the tumour cavity, transferred tissue also sits within the radiotherapy boost field. We describe "relocating the defect", a refinement where the native peripheral breast parenchyma is first mobilised on its intrinsic blood supply to close the tumour cavity directly. The CWPF is then raised and inset only into the more peripheral secondary defect, travelling a shorter distance without aggressive pedicle skeletonisation. The tumour bed is therefore occupied by native tissue rather than flap tissue. We outline the surgical technique with a video detailing the intra-operative steps.