Versatility of the Lateral Intercostal Artery Perforator Flap for Enhancing Outcomes of Autologous Breast Reconstruction

Abstract

Refinements in autologous breast reconstruction (ABR) enable personalized approaches to align with patient preferences. The deep inferior epigastric perforator (DIEP) flap remains the primary choice due to its volume adequacy, but alternative techniques are necessary when volume discrepancies arise. The lateral intercostal artery perforator (LICAP) flap has gained traction in oncoplastic breast reconstruction and has been adapted for autologous augmentation in ABR. This study presents a series of patients in whom the LICAP flap was used to augment the reconstructed or contralateral breast for symmetry. The procedure involves preoperative perforator mapping, dissection of a prepectoral pocket, and inset of the LICAP flap to achieve the desired breast volume and contour. Upon completion of the inset, perfusion is confirmed using Doppler ultrasound or laser angiography. Over a 4-year period, 16 LICAP flaps were performed in 11 patients. The mean LICAP flap volume was 201 cc, demonstrating its capacity to provide an increase of 1 to 2 cup sizes. Indications included bilateral augmentation after DIEP flap reconstruction, correction of asymmetry due to partial flap loss or fat necrosis after DIEP flap reconstruction, and contralateral augmentation for symmetry. No flap failures or fat necrosis cases were reported. Minor complications included cellulitis and donor site seroma. The LICAP flap provides a durable and predictable solution for volume enhancement in ABR, offering an alternative to implants or fat grafting. Limitations in sample size and patient-reported outcomes exist, but this technique expands the reconstructive toolkit, allowing for a more tailored approach to breast reconstruction.