Combination techniques with chest WALL perforator flaps for total breast reconstruction

Abstract

Introduction: Role of chest wall perforator flaps (CWPFs) in total breast reconstruction (TBR) is still being explored. We present four different techniques, which combine CWPFs and other oncoplastic procedures to replace the whole breast volume after mastectomy. These are 1. Extended LICAP and Goldilocks mastectomy, 2. Extended LICAP and MICAP, 3. Extended LICAP, and synchronous fat injection; and 4. Extended LICAP, draped over a small implant. Cases summaries/Results: Five patients had TBR after mastectomy, using combination techniques involving CWPFs. Age ranges from 46 to 78 years, median BMI 35, median mastectomy specimen weight 612g. Four of these patients had immediate reconstruction after mastectomy for breast cancer, one of whom was after chemotherapy. The fifth patient had TBR, as delayed replacement of tissue expander with autologous tissue. For all patients, recovery was uneventful, with median hospital stay of 1 day. There were no surgical complications apart from seroma managed by aspiration in 4/5 patients. Satisfactory breast volume was achieved and maintained after radiotherapy over median follow up of 8 months after surgery. Discussion/Conclusions: CWPF provide a viable and safe alternative for patients not suitable for conventional methods of reconstruction, particularly those with high BMI (patient with highest BMI 46) and of older age (oldest patient 78 yrs.). 4/5 patients had total autologous reconstruction utilising techniques in the current armamentarium of oncoplastic surgeons, obviating the need for microsurgery and prolonged hospital stay.