Oncoplastic Volume Replacement Using Local Perforator Flaps

Introduction

Patients undergoing breast conserving surgery require tumour excision with replacement of the resected tissue to ensure good long-term cosmesis following radiotherapy. Adequate volume replacement can be challenging using local mobilization of glandular tissue alone in the smaller non-ptotic breast. This can be addressed by importing tissue and we describe our unit experience using local perforator flaps.

Methods

Patients undergoing partial mastectomy defect reconstruction with loco-regional perforator flaps were identified. In our unit the LICAP, LTAP and TDAP flaps were used. For the majority of the cases of BCS a two-stage approach was adopted to ensure complete surgical excision and avoid flap compromise if subsequent axillary dissection was required.

Results

Between January and January 2016, twenty two patients underwent unilateral breast reconstruction using twenty LICAP flaps, one LTAP flap and one TDAP flap. In twenty cases surgery was performed following wide local excision of breast cancer and the mean excision volume was 102g. One LTAP flap was performed to augment a previous implant based reconstruction. One TDAP flap was performed for segmental breast reconstruction following partial DIEP flap failure.

All flaps were transferred successfully and the donor sites were closed primarily. One patient had incomplete tumour excision necessitating further excision and one patient required a completion axillary node clearance, both performed at the second stage.  There were no post-operative complications and adjuvant therapy was not delayed. The cosmetic outcomes were good and to date no patients have required further revisional surgery.

Conclusion

Local perforator flaps are reliable and useful for the correction of breast deformity with minimal donor morbidity. Success depends on patient selection and coordinated planning.