Clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer

Yin Ansi; Wu Bin; Quan Yi; Fu Hua; Zuo Huaiquan; Huang Mingquan; Li Yixian; Chen Jianzhe; Song Dajiang; Li Zan; Pan Guangrui

doi:10.3760/cma.j.cn501225-20240625-00249

Volume 41 Issue 7

Jul. 2025

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Yin Ansi, Wu Bin, Quan Yi, et al. Clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2025, 41(7): 680-687. Doi: 10.3760/cma.j.cn501225-20240625-00249

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Clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer

doi: 10.3760/cma.j.cn501225-20240625-00249

1.
Department of Breast Surgery, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
2.
Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha 410008, China

Funds:

Wu Jieping Medical Foundation Clinical Scientific Research Special Funding Grant 320.6750.2022-19-52

More Information

Corresponding author: Pan Guangrui, Email: leftarrow@163.com
Received Date: 2024-06-25

Abstract

Abstract

Objective To investigate the clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer. Methods This study was a retrospective observational study. From January to December 2023, 16 female breast cancer patients who met the inclusion criteria were hospitalized in the Department of Breast Surgery of the Affiliated Hospital of Southwest Medical University, with the age of (48±8) years. The pedicled anterior intercostal artery perforator flap was used for breast reconstruction of patients after breast-conserving surgery. After complete resection of tumor tissue, a "crescent-shaped" incision was designed at the inframammary fold. The pedicled anterior intercostal artery perforator flap was harvested based on the tumor location and the defect area after tumor removal. The flap was de-epithelialized, coapted, and rotated anterogradely or retrogradely to fill the defect. The donor site wound was closed with layered sutures. The following parameters were recorded: breast tissue loss volume during surgery, surgical duration, retention duration of the drainage tube, positive proportion of tumors in the breast incision margin tissue, breast loss ratio, flap survival, and incidence ratio of complications after operation. Patients were followed up for local recurrence or distant metastasis of tumor. At the last follow-up, the Ueda score was used to evaluate cosmetic outcomes of reconstructed breasts after breast-conserving surgery, and the Breast-Q scale version 2.0 was applied to assess patients' satisfaction and quality of life with breast reconstruction after breast-conserving surgery. Results The breast tissue loss volume during surgery in this group of patients was 20-128 (59±34) cm³, the surgical duration was 105-200 (143±27) min, the retention duration of the drainage tube was 3-7 (4.6±1.0) d, and the positive proportion of tumors in the breast incision margin tissue was 1/16, with breast loss ratio of 0. After the surgery, the patient's transplanted flaps all survived. One patient had postoperative fat liquefaction in the surgical area, and the incidence ratio of postoperative complications was 1/16. The patients were followed up for 3-12 (11±4) months, and no local breast cancer recurrence or distant metastasis occurred. At the last follow-up, the cosmetic score of breast reconstruction after breast-conserving surgery were excellent in 6 cases, good in 8 cases, and fair in 2 cases, with an excellent and good ratio of 14/16. At the last follow-up, the highest score in the evaluation of patients' satisfaction with breast reconstruction and quality of life after breast-conserving surgery was the satisfaction with the surgeons, with a score of 59-100 (91±13), followed respectively by physiological health of the chest with a score of 60-100 (77±14), psychological health with a score of 35-100 (74±20), breast satisfaction with a score of 55-100 (73±13), satisfaction with information acquisition with a score of 53-100 (70±14), and sexual health with a score of 34-100 (70±23). Conclusions The pedicled anterior intercostal artery perforator flap is safe and reliable for breast reconstruction after breast-conserving surgery for breast cancer, and can achieve high cosmetic effects and patient satisfaction. This flap is simple in design, easy to operate and highly reproducible, and is worthy of clinical promotion and application.
- Breast neoplasms,
- Perforator flap,
- Anterior intercostal artery perforator flap,
- Breast reconstruction after breast-conserving surgery,
- Wound repair

(1) The pedicled anterior intercostal artery perforator flap had diverse designs, was easily to obtain, and had a reliable blood supply. The use of this flap to repair the defects after breast-conserving surgery for breast cancer belongs to volume replacement, which could repair larger tissue defects and maintain good breast shape compared with volume displacement.
(2) The pedicled anterior intercostal artery perforator flap had a concealed incision and could achieve good aesthetic effect, especially suitable for breast reconstruction after breast-conserving surgery for small- and medium-sized breasts in Asian populations, which was of great benefit to the improvement of breast-conserving rate of Chinese women with breast cancer.

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References(40)

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