The Comparison of Two Surgical Techniques for Effective Utilization of Lateral Intercostal Artery Perforator Flap in Immediately Partial Breast Reconstruction: Propeller Method VS Turnover Method, a Single-Center Retrospective Study in Asia.

Background:Immediate partial breast reconstruction (IPBS) after breast-conserving surgery (BCS) has become a new paradigm in treating breast cancer.^1,2Among the volume replacement techniques used for small to moderate-sized breasts, the perforator flap method has many advantages. Specially, breast reconstruction using the LICAP flap provided excellent cosmetic results in lateral defects where a variety of surgical methods, such as the LD flap, perforator flap, and regional flap could be used. We report usefulness of lateral intercostal artery perforator (LICAP) flap by utilizing two surgical technique and anatomic studies by using 3D-CT.

 

Methods:This study included 40 patients taken IPBS using LICAP flap after BCS from 2011 to 2016 at our hospital. We used 3D-CT in LICAP anatomical studies, analyzing the distribution probability of the dominant perforator and relationship with surrounding tissues. We conducted comparative analyses of the propeller method and the turnover method of LICAP flap. Patient satisfaction surveys were conducted 6 months following breast reconstruction by using our institution’s Breast satisfactory survey by combining patient and three plastic surgeons.

 

Results:In anatomic studies of LICAP, the most dominant perforator utilizing for LICAP flaps among patients in this study were the 6^thLICAP, utilized in 43.6% of cases, followed by the 7^thLICAP, utilized in 39.1% of cases, and their mean distances from the latissimus dorsi and the axillary folds were determined and reported. With respect to complications, a total of 3 cases required additional treatment for fat necrosis(propeller method - 2 cases, turnover method - 1 case), and venous congestionwas found in only 2 cases that used thepropeller method. Cosmetic satisfaction was ≥90% for both techniques, indicating results that were rated as either excellent or good. reported by patients and surgeons.

 

Conclusion:Until now, the LICAP flap has not been widely used compared to other surgical techniques, due to limitations of flap ranges of movement and the difficulty of the surgical method.³ But, although this study also has difficulty in representing LICAP in all cases because there is a limitation using 40 patients in single medical institution, we believe that our study results can broaden the application of partial breast reconstruction using the LICAP flap after BCS, with anatomic studies using 3D-CT, and using one of our two described surgical techniques through this study. When performing LICAP flap-based breast reconstruction, 3D-CT was useful for selection of dominant perforator in the patient before surgery and perforator dissection during surgery. And, by choosing the most appropriate of the two techniques according to the patient’s situation, more satisfactory results and fewer complications can be obtained.As in this study, if 3D-CT is used to obtain perforator information sufficiently before surgery, and if the surgical methods described here are selected for the case, it is likely that the LICAP flap will become more widely used, thereby providing patients the excellent cosmetic results.