Evaluation of Anterior Intercostal Artery Perforator Flap for Oncoplastic Immediate Reconstruction Following Breast-Conserving Surgery in Lower Breast Quadrants Lesions; an Institutional-Based Study

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Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt

Abstract

Introduction: The incorporation of oncoplastic surgery techniques in the management of breast cancer became
more popular and offers both oncological safety and good cosmetic results. It is highly challenging for surgeons
to obtain good oncological control and acceptable cosmetic results, especially in tumors in the lower quadrant of
the breast. The utility of anterior Intercostal Artery perforator flap (AICAP) in immediate reconstruction following
breast-conserving surgery (BCS) is rarely described in the literature. In our study, we present our experience with
the Anterior Intercostal Artery Perforator flap in 20 patients with small to medium-sized breasts.
Patients and methods: From June 2018 to June 2021, twenty female patients underwent quadrantectomy
followed by reconstruction using an AICAP flap.
Results: The surgical excision margins were negative in all patients and no re-excision was needed. The dimensions
of the flap were matching the defect size or were slightly larger due to anticipation of tissue shrinkage post
radiation, with a mean of 7 × 5 × 3 cm (range of 4.6–10 × 3–6× 2–5 cm). The postoperative complications were
observed in only one patient (5%) in the form of mild wound infection. An average percentage of excellent to good
results was obtained in 95% of cases.
Conclusion: The AICAP flap is an important addition in the field of oncoplastic immediate reconstruction after
BCS, especially in patients with small to moderate breast sizes. The technique is oncologically safe and provides
improved aesthetic results after quadrantectomy for tumors in the lower quadrants of the breast.

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