From Innovation to Underutilization: Why Chest Wall Perforator Flaps Have Not Achieved Widespread Adoption—Insights from the Literature and a High-Volume Single-Center Cohort

Background/Objectives: Chest wall perforator flaps (CWPF) have emerged as versatile muscle-sparing volume replacement techniques in oncoplastic breast surgery (OBS), facilitating breast conservation in selected patients with favorable tumor-to-breast ratio. However, their adoption into routine practice remains limited. The aim of this study was to explore the factors contributing to the underutilization of CWPF in OBS through a narrative review of the current literature along with insights from a high-volume single-center experience in Greece. Materials and Methods: A comprehensive search of PubMed/MEDLINE and Scopus (2004–2026) was performed using predefined keywords related to CWPF, partial breast reconstruction (PBR), breast-conserving surgery (BCS) and OBS. Eligible studies addressing surgical outcomes, patient selection, technical variations, patient satisfaction and barriers to implementation were analyzed qualitatively, due to heterogeneity of study designs and outcome reporting. The institutional cohort included patients undergoing CWPF-based PBR following BCS between May 2018 and December 2025, with data extracted from a prospectively maintained institutional database and analyzed descriptively.