Breast conserving surgery followed by radiotherapy is the gold standard treatment for
early breast cancer. Cases with unfavorable tumor volume to breast volume ratio or
challenging localizations are at higher risk of margin infiltration or poor aesthetic
outcomes. While margin infiltration represents one of the strongest predictors of local
recurrence, unappealing cosmetic results may significantly impair survivors' quality of
life. Over the past two decades, the adoption of oncoplastic breast conserving surgery
(OBCS) techniques has shown promise in improving both oncological and aesthetic outcomes
after breast cancer surgery. Partial breast volume reconstruction (PBR) after OBCS is
obtained through volume displacement (which involves remodelling and redistributing
glandular tissue) and volume replacement (when the volume used to reconstruct the defect
comes from an extramammary site) techniques.
One of the greatest examples of volume replacement techniques in breast surgery involves
the use of chest wall perforator flaps (CWPF). The use of these well-vascularized
dermo-adipose flaps offers oncologically safe wide resection while obtaining excellent
cosmetic outcomes. It is particularly suitable for patients with non-ptotic small to
medium-sized breasts and cases with an unfavorable tumor volume to breast volume ratio.
CWPFs can decrease mastectomy rates in breast cancer surgery, thus avoiding the
disadvantages associated with implant-based reconstruction. Consequently, the need of
contralateral simmetrization is also diminished.
CWPFs are vascularized by perforator arteries that arise from the chest wall (mainly
branches of the axillary artery, or intercostal arteries deriving from the internal
mammary artery). While cadaver labs and radiologic studies demonstrated a reliable and
coherent localization of perforator arteries, the use of Doppler Ultrasound is often
required to localize the perforators and test their reliability. Compared to the
traditional myocutaneous flaps (such as the latissimus dorsi flap), CWPFs spare the
underlying muscles minimizing donor site morbidity and enabling rapid post-operative
recovery, low post-operative complication rates, post-operative pain, and loss of
function. All these advantages may result in high levels of patients' satisfaction.
Additionally, CWPFs avoid the microsurgical anastomoses required for free flaps.
All breast quadrants defects could be restored with CWPFs, with the Thoraco-Dorsal Artery
Perforator (TDAP), Lateral-Thoracic Artery Perforators (LTAP) and Lateral Intercostal
Artery Perforator (LICAP) Flaps particularly suitable for reconstructing lateral
quadrant; the Anterior Intercostal Artery Perforator (AICAP) Flap for the lower quadrants
and the Internal Mammary Artery Perforator (IMAP) Flaps for volume defects at inner
quadrants.
Although existing literature reports promising results, the use of CWPFs remains
emerging, and OBCS with CWPFs is currently limited to select high-volume breast centers.
The collection of robust clinical data is essential to validate these potential
advantages and facilitate the broader adoption of this technique.
This multicentric retrospective observational study aims to collect evidence about the
surgical and oncological outcomes of OBCS with CWPFs, to evaluate the potential benefits
associated with the use of this innovative technique.