Can we save this breast? Local perforator flaps that make it possible!

On the heels of Covid-19, the excision of larger tumours has become quite challenging. But, we keep pushing boundaries and seem to find ways to replace the volume excised to obtain not only a good oncologic but also an esthetic result. The use of intercostal perforator flaps, also known as chest wall perforator flaps, has been recently introduced in breast cancer surgery. We report our centre experience using these local perforator flaps. The study is a retrospective observational cohort of a small series of patients who underwent breast conservation surgery relying on perforator flaps for volume replacement from August 2022 to January 2023. Seven patients were included in the study. Clinicopathological, surgical details, adjuvant treatment were retrieved from the Institutional electronic register system. Four lateral, two anterior and one anterior and lateral intercostal artery perforators were utilized. All tumours were close to two cms or greater and located in the external or inferior breast quadrants. Three patients had tumor invasion of the skin where skin islands were needed. IPF has been found by us to be a very useful technique for partial breast reconstruction in women who have some skin laxity and sufficient subcutaneous fatty tissue to replace the volume of the breast tumour defect with a local perforator flap after excision of the tumor. Although the series is small with a short follow-up, we saw no complications. Patient satisfaction was very good. However, more time is needed to see how the flaps do under exposure to radiotherapy.