One-stage vs. two-stage approach for partial breast reconstruction with lateral chest wall perforator flaps

BackgroundThe lateral chest wall perforator flaps offer an excellent option for partial breast reconstruction (PBR) in women undergoing breast conservation surgery (BCS) for laterally placed tumours in small to moderate non-ptotic breasts.MethodsWe have performed 40 PBR, including LICAP (Lateral intercostal artery perforator) and LTAP (Lateral thoracic artery perforator) flaps over a three-year period. 29 were performed as one-stage whilst 11 were performed as two-stage approach. The latter approach was undertaken for patients with high tumour to breast ratio in an attempt to extend the indication for breast conservation.ResultsOut of 40 patients, 27 were symptomatic and 13 were screen-detected with a mean age of 49 years. The overall median tumour size on pre-op imaging was 35 mm and was 47 mm for the ones selected for two-stage approach. 11 patients underwent neo-adjuvant chemotherapy and additional 14 had adjuvant chemotherapy. All but one patient had adjuvant radiotherapy to the breast. 4 patients (10%) required further surgery to the breast due to incomplete cancer excision; 2 underwent successful re-excision and 2 (5%) were recommended completion mastectomy. A high satisfaction scores were reported both by the patients and surgical team with regards to the aesthetic outcome. There were no significant differences observed in complications, aesthetic outcome or patient satisfaction levels with the two approaches. Patients undergoing two-stage approach had an extra periareolar scar (in majority of the cases), which faded well with radiotherapy.ConclusionWe recommend considering two-stage approach in women with high tumour to breast size ratio to ensure successful BCS prior to PBR.