Local Perforator Flaps in Oncoplastic Breast Surgery: Clinical Applications of ICAP and TDAP Flaps in Reconstruction and Complication Management

Georg Schmidt; Theresa Mayo; Angela von Falkenhausen; Marion Kiechle; Daniel Müller

doi:10.1055/a-2708-5818

Geburtshilfe und Frauenheilkunde, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd
DOI: 10.1055/a-2708-5818

GebFra Science

Original Article

Local Perforator Flaps in Oncoplastic Breast Surgery: Clinical Applications of ICAP and TDAP Flaps in Reconstruction and Complication Management

Lokale Perforatorlappen in der onkoplastischen Brustchirurgie: klinische Anwendung von ICAP- und TDAP-Lappen in der Rekonstruktion und im Komplikationsmanagement

Authors

Georg Schmidt

¹Department of Gynecology and Obstetrics, TUM University Hospital and Comprehensive Cancer Center (CCCTUM), Technical University Munich, Munich, Germany (Ringgold ID: RIN9184)
Theresa Mayo

¹Department of Gynecology and Obstetrics, TUM University Hospital and Comprehensive Cancer Center (CCCTUM), Technical University Munich, Munich, Germany (Ringgold ID: RIN9184)
Angela von Falkenhausen

¹Department of Gynecology and Obstetrics, TUM University Hospital and Comprehensive Cancer Center (CCCTUM), Technical University Munich, Munich, Germany (Ringgold ID: RIN9184)
Marion Kiechle

¹Department of Gynecology and Obstetrics, TUM University Hospital and Comprehensive Cancer Center (CCCTUM), Technical University Munich, Munich, Germany (Ringgold ID: RIN9184)
Daniel Müller

¹Department of Gynecology and Obstetrics, TUM University Hospital and Comprehensive Cancer Center (CCCTUM), Technical University Munich, Munich, Germany (Ringgold ID: RIN9184)

Abstract

Introduction

Local perforator flaps have become an increasingly important option in oncoplastic breast surgery. Despite their long-standing use, their application in clinical practice remains limited. This study evaluates the use of thoracic wall perforator flaps, specifically the intercostal artery perforator (ICAP) and thoracodorsal artery perforator (TDAP) flaps, for volume and skin replacement after breast-conserving therapy and in the management of complications following reconstructive procedures.

Materials and Methods

We performed a retrospective analysis of 50 patients treated with local perforator flaps between March 2022 and March 2025 at the Interdisciplinary Breast Center, Klinikum rechts der Isar. Follow-up examinations were conducted in a standardized manner by the primary surgeon and included clinical and ultrasound assessments of the flap, as well as documentation of complications, perfusion, and patient-reported outcomes.

Results

ICAP flaps were used in 39 cases and TDAP flaps in 11 cases. The majority of reconstructions (72%) were immediate. ICAP flaps were mainly used for lower and central defects, whereas TDAP flaps were used for upper outer quadrant and complex cases. The mean operative time was 109 minutes, longer for TDAP flaps (153 minutes). There was no total flap loss and complications were rare (one partial necrosis, three seromas). Radiotherapy was administered in 72% of cases without flap compromise. Flaps were also effective in the management of implant-related or autologous reconstruction complications.

Discussion

Perforator flaps offer reliable, low morbidity reconstruction options with good aesthetic outcomes and low complication rates, even after radiotherapy. They are also suitable for secondary reconstruction and management of complications.

Conclusion

Local perforator flaps, particularly ICAP and TDAP, are safe, versatile tools in oncoplastic breast surgery and should be more widely considered in clinical practice.

Zusammenfassung

Einleitung

Lokale Perforatorlappen haben in der onkoplastischen Brustchirurgie zunehmend an Bedeutung gewonnen. Obwohl diese Techniken seit vielen Jahren etabliert sind, werden sie in der klinischen Praxis bislang nur eingeschränkt eingesetzt. Ziel dieser Studie war es, den Einsatz thorakaler Perforatorlappen – insbesondere des Intercostal Artery Perforator (ICAP) und des Thoracodorsal Artery Perforator (TDAP) Flaps – sowohl zur Volumen- und Hautrekonstruktion nach brusterhaltender Therapie als auch im Management von Komplikationen nach rekonstruktiven Eingriffen zu evaluieren.

Material und Methoden

Es erfolgte eine retrospektive Analyse von 50 Patientinnen, die zwischen März 2022 und März 2025 am Interdisziplinären Brustzentrum des Klinikums rechts der Isar mit lokalen Perforatorlappen behandelt wurden. Die Nachsorge erfolgte standardisiert und umfasste klinische und sonografische Untersuchungen des Lappens sowie die Dokumentation von Komplikationen, Lappenperfusion und Zufriedenheit der Patientinnen.

Ergebnisse

ICAP-Lappen wurden in 39, TDAP-Lappen in 11 Fällen eingesetzt. Der Großteil der Rekonstruktionen (72%) erfolgte primär. ICAP-Lappen wurden überwiegend für Defekte in den unteren Quadranten und zentral verwendet, während TDAP-Lappen vor allem bei Defekten im oberen äußeren Quadranten und bei komplexen Fällen genutzt wurden. Die mittlere Operationszeit betrug 109 Minuten und war bei TDAP-Lappen länger (153 Minuten). Es traten weder vollständige Lappenverluste auf, noch kam es zu schwerwiegenden Komplikationen; dokumentiert wurden lediglich 1 partielle Nekrose und 3 Serome. Eine adjuvante Radiotherapie wurde in 72% der Fälle durchgeführt, ohne dass die Rekonstruktion hierdurch beeinträchtigt wurde. Darüber hinaus erwiesen sich die Lappen als wirksame Option im Management von Komplikationen nach implantatbasierter oder autologer Rekonstruktion.

Diskussion

Perforatorlappen stellen eine verlässliche und komplikationsarme Rekonstruktionsmethode mit guten ästhetischen Ergebnissen dar – auch nach Radiotherapie. Darüber hinaus sind sie für sekundäre Rekonstruktionen sowie für das Management von Komplikationen geeignet.

Schlussfolgerung

Lokale Perforatorlappen, insbesondere ICAP- und TDAP-Lappen, stellen sichere, vielseitige und effektive Instrumente in der onkoplastischen Brustchirurgie dar und sollten in der klinischen Praxis breitere Anwendung finden.

Keywords

breast cancer - oncoplastic breast surgery - perforator flap surgery - breast conserving surgery

Schlüsselwörter

Mammakarzinom - onkoplastische Brustchirurgie - Perforatorlappen - brusterhaltende Operation

Full Text

References

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