American Association of Plastic Surgeons

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Anterior Intercostal Perforator Flap for Breast Reconstruction
Kimberly S. Khorui, B.S.1, Claudio Angrigiani, MD2.
1NYU School of Medicine, Key Biscayne, FL, USA, 2President Marko Foundation, Buenos Aires, Argentina.

PURPOSE:The lateral thoracic area has been used as a flap for decades. Flow comes from the superficial branch of the internal mammary artery and/or perforators of the intercostal arteries. The anterior perforators of the intercostal artery have been utilized as turn-over flaps from the anterior wall. They are also the vascular support for the inferior pedicle flap in breast reduction. We therefore created a lateral design of the anterior intercostal perforator with donor-site scar hidden in the bra-line and no additional backside involvement. We can also harvest enough skin to reconstruct the nipple areola complex (NAC) in immediate breast reconstruction after skin sparing mastectomy (SSM). To our knowledge this is a novel design of the flap raised as a perforator.
METHODS:We performed 12 cases of the lateral design of the anterior intercostal perforator. The NAC was reconstructed after SSM in 2 cases. In 10 cases 300-340cc implants were replaced with the lateral intercostal perforator flap. Flaps were harvested 3-4cm above and below the inframammary fold. The anterior intercostal perforator of the 5th intercostal space was used for flap irrigation.
RESULTS:We gained an average breast volume of 260cc after de-epithelialization. There were no major complications.
CONCLUSION:The lateral design of the anterior intercostal perforator flap is a novel and reliable flap for autologous breast reconstruction that results in significant volume and minimal donor site scarring.


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