Perforator Flaps

What is a perforator flap?

A perforator flap is an island of skin and the underlying fat that is moved to replace a defect in the breast. The blood supply of the tissue must be preserved for the flap to survive. There are two types Dr Graham commonly uses:

1. Lateral Intercostal Artery Perforator Flap (LICAP) usually used for cancers on the outer half of the breast

2. Anterior Intercostal Artery Perforator Flap (AICAP) usually used for cancers on the bottom half of the breast

Who is suitable for this flap?

This operation is suitable for some patients who have their breast cancer in the outer or lower part of the breast when removal of the tumour alone will not leave an acceptable cosmetic outcome. The aim is to replace the breast tissue removed at the time of cancer surgery with skin and fat from an area outside of the breast. It is usually performed in combination with a wide local excision (lumpectomy). Sometimes this procedure is performed to correct a defect in the breast from previous surgery.

What happens during the operation?

There is no muscle removed in this operation, therefore there is no effect on your arm or chest wall function. You will have quite a long scar on the side of your chest wall going towards your back (LICAP) or a scar underneath the breast in the line of the breast fold (AICAP). There is usually no additional scar on the breast. The aim of this operation is to remove the tissue lost from your breast and to restore its size and shape. Radiotherapy in combination with surgery may affect the appearance and feel of you breast in the longer term.

How long is the operation and what is the recovery like?

The operation usually takes about 2 hours. The duration will depend on what other surgery for the breast and lymph nodes is occurring at the same time. You will stay in hospital for at least one night, but it may be longer depending on other procedures that occur at the same time.

This surgery is not usually associated with severe pain but you will need some pain relief afterwards. As this operation involves moving the breast tissue around, the pain/discomfort you feel may not be directly under the scar.

A waterproof dressing will be placed on your wound. Most women spend one night in hospital following surgery. You will be able to do most things for yourself immediately after the operation and are encouraged to do so.

What are the benefits of a perforator flap?

The main benefit of surgery is that the cancer is removed from the breast and the shape of the breast is able to be maintained. A perforator flap allows Dr Graham to take more tissue than she could otherwise if she did not use a flap. This means some patients can avoid a mastectomy and others can have a larger margin of healthy tissue taken around the tumour.

What are the complications of a perforator flap?

All operations have potential side effects and complications. Fortunately, these are uncommon and surgery usually proceeds without any problems. Dr Graham will the risks and possible complications with you in detail at your consultation.

Risks are increased in patients who smoke or have other medical conditions that impair healing, such as diabetes. These complications include but are not limited to pain, bleeding, infection, need for further surgery, loss of the flap due to impaired blood supply, loss of skin sensation, wound healing problems, breast asymmetry and seroma.

Dr Graham advocates the National Law and Australian Health Practitioner Regulation Agency (AHPRA) guidelines that any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.