Use of lateral intercostal artery perforator flaps in breast-conserving surgery for breast cancer: a single-center experience

Background: Breast-conserving surgery (BCS) combined with radiotherapy has become a standard treatment for early-stage breast cancer, providing oncologic outcomes comparable to mastectomy while preserving breast aesthetics. However, large-volume resections may result in contour deformities and poor cosmetic outcomes. Perforator flaps such as the lateral intercostal artery perforator (LICAP) and anterior intercostal artery perforator (AICAP) flaps have emerged as valuable oncoplastic techniques for immediate volume replacement. This study aimed to report a single-center experience using LICAP and AICAP flaps following BCS.

Methods: A retrospective observational single-center study was performed between April 2024 and April 2025. Consecutive patients undergoing BCS with immediate reconstruction using LICAP or AICAP flaps were included. Demographic data, tumor characteristics, surgical outcomes, complications, aesthetic results, and timing of adjuvant therapy were analyzed. Descriptive statistics were used.

Results: Fifteen patients underwent reconstruction, predominantly using LICAP flaps (93.3%), with a single case of AICAP reconstruction (6.7%). Invasive carcinoma was identified in 73.3% of cases, with a mean tumor size of 41.7 mm. All flaps remained viable, with no cases of partial or total necrosis. All patients initiated adjuvant therapy within 12 weeks postoperatively. After a mean follow-up of 20 months, no local recurrences were observed.

Conclusions: LICAP flap reconstruction may represent a feasible and effective option for immediate volume replacement following BCS in selected patients. However, these findings must be interpreted within the context of the study’s limitations, due to the small sample size, lack of a control group, and limited follow-up. Further studies with larger cohorts and longer follow-up are required to confirm these preliminary results.