Background: Oncoplastic breast conserving surgery has evolved to allow for higher breast volume excision without compromising cosmesis. Volume replacement, involving the use of autologous tissue, aims to fill the excised defect thus eliminating deformity and maintaining breast appearance. There are a variety of chest wall perforator flaps (CWPF) including lateral intercostal artery perforator (LICAP), anterior intercostal artery perforator (AICAP), and medial intercostal artery perforator (MICAP) flaps. The aim of this study was to assess the oncological and surgical outcomes of patients undergoing CWPF in a single tertiary centre.
Methods: A retrospective database was created analysing all patients who underwent partial breast reconstruction using a CWPF in a single tertiary centre in Dublin. Data collected included patient demographics, tumour characteristics, type of perforator flap and complications. Re-excision was defined as a positive margin(s) requiring re-excision following inset of the CWPF. Descriptive analyses (mean, median and percentages) were used to analyse the data set.
Results: Between 2017 and 2023, twenty-eight patients underwent partial breast reconstruction using a chest wall perforator. Mean age was 52 years old (range: 35–76 years). Seventeen patients presented symptomatically, with the remaining eleven patients diagnosed via the national breast screening programme. Median whole tumour size was 26.5 mm (range: 15–60 mm) based on the maximum size on any imaging modality [mammogram, ultrasound, magnetic resonance imaging (MRI)]. Median specimen weight was 48 grams (range: 12–205 grams). Invasive ductal carcinoma accounted for 67.8% (19/28) of invasive cancers followed by invasive lobular carcinoma 14.2% (4/28). Ductal carcinoma in situ accounted for 14.2% (4/28) of the patient cohort with one case of a phyllodes tumour. The majority of patients underwent a single-stage procedure, with six patients undergoing a two-stage procedure whereby the excision cavity was filled with water pending pathology results. Of the 28 flaps, 17 were LICAP flaps, 6 AICAP flaps and 5 MICAP flaps. The re-excision rate was 7% (2/28), with a 10.7% (3/28) conversion to mastectomy rate. Overall complication rate was 10.7% (3/28) with all being post-operative infections. None required return to theatre. There were no flap losses.
Conclusions: CWPF are a safe means of providing volume replacement in breast conserving surgery with acceptable oncological outcomes and post-operative complication rates. This study highlights the role for oncoplastic breast surgery techniques in the treatment of higher volume breast excision. Going forward, a larger prospective patient cohort and longer-term follow-up is required.
