Modifications of the LICAP/LTAP Flap Technique in Partial Breast Reconstruction for Difficult Tumor Locations

Abstract

The authors propose modifications of the lateral thoracic artery perforator/lateral intercostal artery perforator flap partial breast reconstruction that can help achieve improved aesthetic results, especially for centrally and medially located tumors. Lumpectomy is performed using the retromammary approach through lateral contour access without skin mobilization from parenchyma. This minimizes trauma and scarring of parenchyma and skin in the lateral part of the breast. In case of central or medial location of the tumor, the authors propose moving the flap into the tumor bed through a cut ("window") in the musculus pectoralis major. This helps stabilize the flap in an optimal position and redistribute the tissue without compression on the flap pedicle or bulge in the lateral sector of the gland. The authors have used this modification in 18 patients. The average tumor size was 2.8 cm (range, 1.2 to 5.4 cm) and the average weight of the specimens was 46.6 g (range, 14 to 110 g). Two patients had a tumor in the upper-inner quadrant close to the breast meridian, two in a central-lateral tumor location, and 14 in the upper-outer quadrant. Early complications occurred in four cases: two seromas of the wound, one partial flap necrosis with revision and resection of the flap, and one cellulite in the axillary region after axillary dissection because of long-standing lymphorrhea and drainage. The proposed modification of the lateral thoracic artery perforator/lateral intercostal artery perforator flap technique in partial breast reconstruction can lead to better aesthetic results and improved safety.