New Approach to Oncoplastic Breast Conservation: Combining Autologous Volume Replacement and the Wise-pattern Mammaplasty

Abstract

Background:Oncoplastic breast-conserving surgery describes a set of techniques that allow for generous oncological resection with immediate tumor-specific reconstruction. These techniques are classically divided into either volume displacement (local breast flaps and or reduction mammaplasty/mastopexy strategies) versus volume replacement strategies (transfer of autologous nonbreast tissue from a local or distant site and, less commonly, implant placement). There have been few descriptions of merging these 2 classical approaches to facilitate breast-conserving surgery. The purpose of this report was to evaluate the efficacy of combining the most common oncoplastic volume displacement strategy (Wise pattern mammaplasty) with simultaneous autologous volume replacement from the lateral intercostal artery perforator (LICAP) flap to reconstruct the extensive partial mastectomy defect in patients with ptosis.Methods:A retrospective analysis of 25 consecutive patients with multifocal or multicentric breast cancers who underwent simultaneous volume replacement from the LICAP flap and volume displacement (Wise pattern mammaplasty) to achieve breast conservation was performed between January 2016 and January 2018. Clinical outcomes and postoperative complications were examined.Results:Twenty-five consecutive patients with a mean age of 56 years (range, 37–74 years) and mean body mass index of 28 kg/m2 (range, 22–37 kg/m2) all successfully underwent breast conservation by simultaneously employing the LICAP flap and Wise pattern mammaplasty to reconstruct the partial mastectomy defect. The average resection specimen weight was 220 g (range, 130–310 g) and average size of the malignancy resected was 6.5 cm (range, 3.7–9.2 cm). Three patients (12%) required re-excision for close or positive margins but were ultimately cleared. There were no complications related to the donor site. There were 4 patients (16%) with delayed wound healing related to the Wise pattern closure but no instances of LICAP necrosis or failure.Conclusions:The merger of Wise pattern volume displacement and autologous volume replacement techniques represents a novel strategy that is useful in the most challenging breast conservation patients with some degree of ptosis.

No Doppler Single Position‐Lateral Intercostal Artery Perforator Flap (NDSP‐LICAP): a Safe and Versatile Flap for Breast Oncoplasty in Resource‐Limited Setting

“…Cadaveric dissections have demonstrated that lateral intercostal artery perforator is found between 2.6 and 3.5 cm anterior to the anterior border of latissimus dorsi which is the area between anterior and mid‐axillary line. Hamidi et al in their follow‐up study detailed that dominant perforator to the flap is consistent in its location and is found commonly in sixth and seventh intercostal space 2.5–3.5 cm from anterior edge of latissimus dorsi muscle [3, 12]. In our entire study, we preserved the tissue in the said area and found that it was 100% effective and safe for the viability of the flap and we did not have any partial or complete flap loss.…”

Combining Wise-pattern Volume Displacement and Autologous Volume Replacement to Facilitate Oncoplastic Breast Conservation

“…In 2018, the author published the first description of combining autologous VR and Wise-pattern VD for challenging cases of oncoplastic breast-conserving surgery. 12 That report described combining a Wise-pattern mastopexy and an extended lateral intercostal artery perforator (LICAP) flap to harvest tissue from the back to reconstruct defects regardless of their breast location. We have since abandoned the extended LICAP flap for the muscle-sparing latissimus dorsi (MSLD) flap, which has superior blood flow, when such large volumes are required for VR.…”

Lateral intercostal artery perforator (LICAP) flap for breast volume augmentation: Applications for oncoplastic and massive weight loss surgery

“… 2 , 3 For women with small breasts and adequate local tissue, autologous volume augmentation is often required when a large amount of gland is removed. 4 Current options for autologous volume augmentation include the thoracodorsal artery perforator (TDAP) flap, the spiral flap, and serial fat grafting. Among the current techniques, the LICAP flap provides benefits of repurposing local tissue by addressing axillary tissue excess, while maintaining a reliable tissue source due to its robust blood supply.…”