To explore the feasibility and cosmetic effect of repairing partial breast defects with pedicled lateral thoracic artery perforator(LTAP) flap.

Pedicled LTAP flap was applied to repair partial breast defects in 12 patients from the Department of Breast Surgery of Shenzhen Maternal and Child Health Hospital of Southern Medical University from May 2019 to October 2020. Before the operation, the Doppler ultrasound was used to explore the perforator branch of the lateral thoracic artery in the 3rd to 4th intercostal area of the lateral thoracic wall, and a transverse or nearly transverse pedicled LTAP flap containing the perforator branch was designed. During the operation, the flap was elevated from the deep surface of the deep fascia, through which the lateral thoracic vessels were faintly visible. Then the vascular direction was determined with an audible Doppler blood flow detector. From the deep fat layer and the deep surface of the deep fascia, the pedicle with a width of about 1.2 cm and a thickness of about 0.5 cm was formed by careful dissection along the main vessel to the axillary direction. The flap was transferred to the breast defect after the epidermis of the flap was removed. The survival of the flaps was observed, and the reconstructed breast shape was evaluated.

A total of 12 patients were included. All patients were female, aged from 32 to 58 years old, with an average of 41.7 years. Among them, there were 8 cases of breast cancer and 4 cases of non-lactation mastitis. The lesions were all located in the lateral breast area. In this study, the tissue weight of tumor or inflammatory lesions was (78.3±5.1) g(56-92 g), and the LTAP flap with pedicle was (9.3±0.6) cm (8.2-12.5 cm)in length and (5.6±0.4) cm(3.8-7.2 cm) in width. In this group, 1 patient developed an infection of the donor site drainage entrance. After wound dressing and taking oral antibiotics, the wound healed quickly and healed well. Postoperative follow-up was conducted for 2-17 months, with an average of 8.2 months. There were 10 cases with good cosmetic effect and 2 cases with average cosmetic effect, and there were no patients with poor cosmetic effect. All patients were satisfied with the shapes of the reconstructed breasts. Among them, 5 patients completed radiotherapy, and the appearance change of the breast was not obvious. All patients were followed up and underwent color ultrasound examination of the breasts, which showed that the flaps survived well. There was no recurrence of tumor or inflammation.

Pedicled LTAP flap is an alternative operation scheme for partial breast reconstruction after breast-conserving surgery for breast cancer or lesion resection for non-lactation mastitis, especially for reconstructing of the lateral region. It has the advantages of simple operation, easy survival of the flaps, low complications, and relatively hidden incisions.

Perforator flap; Ultrasound examination; Breast neoplasms; Reconstructive surgical procedures; Lateral thoracic artery