Immediate Conservative Breast Surgery Reconstruction With Pedicled Intercostal Vascular Perforator Adipofacial Flap

Objective: To discuss the feasibility,design of surgical incision and pedicled intercostal artery perforator adipofacia flap(ICAP adipofacia flap),and to evaluate the outcome of immediate partial breast reconstruction(IPER)after breast conserving surgery(BCS)for breast cancer patients.Methods: From June 2013 to June 2016,24 breast cancer patients underwent IPER after BCS with ICAP adipofacia flap,all these adipofacia tissue were based on perforators originating from costal and muscular segment of the intercostal vessels.Preoprative incision and flap were designed based on ultrasound and magnetic resonance imaging(MRI).Flap and donor-site complications were evaluated.Information on aesthetic results and patient satisfaction was collected.Results: The Median follow-up time was 18 months with a range of6-30 months.1 or 2 perforators were found between 5 and 8 intercostal space around midaxillary line.Flap necrosis and seroma in the donor-site were not found in all patients,two presented flap ischemia and disappeared respectively 3 or 5 months later.Cosmetic evaluation showed 5 excellence,13 good,6 common.16 patients conducted reexamination at our hospital,and the results showed the average volume difference of breasts value was24.3ml,and the mean ratio of volume difference to breast volume was4.1%,median ratio was 3.3%(5%-17.7%).About 91.6% patients and83.3% patients were satisfied with the general process and cosmetic process.Conclusions: The lateral pedicled intercostal artery perforatoradipofacia flap(LICAP adipofacia flap)is a technique for conservative breast surgery reconstruction with high feasibility and reliability.Success depends on patient selection,Precious pre-operative preparation and careful intraoperative management.The operation including extended lumpectomy and flap dissection is conducted under the skin,which may produce less scar.MRI is an important assistive technology during the whole process which allow surgeons completing precise resection and quantitative analysis...