title: Immediate conservative breast surgery reconstruction with perforator flaps: new challenges in the era of partial mastectomy reconstruction?
abstract: BACKGROUND
  Although the use of local flaps in conservative breast surgery (CBS) reconstruction is a reliable technique, little information has been available regarding outcome following the use of perforator flaps. The purpose of this study is to analyze the feasibility, surgical planning and outcome following CBS reconstruction with intercostal artery perforator (ICAP) flap.
  
  
  METHODS
  Thirteen patients underwent CBS reconstructions with an ICAP flap. These ﬂaps were raised from adjacent tissue located on the lateral and thoracic region and based on perforators originating from the costal and muscular segment of the intercostal vessels. The technique was indicated in patients with small/moderate volume breasts.
  
  
  RESULTS
  Mean time of follow-up was 32 months. Flap complications were evaluated and information on patient satisfaction were collected. 61.5 percent had tumors located in the lower-outer quadrants and 69.2 percent had tumors measuring 2 cm or less (T1). Complications occurred in 3 patients (23%), including wound dehiscence in 2 patients and fat necrosis in one. All cases were treated by conservative approach with a good result. No ﬂap loss or wound infection were reported. 90 percent were either satisfied or very satisfied with their result.
  
  
  CONCLUSIONS
  The ICAP flap is a reliable technique for immediate CBS reconstruction. The technique is advantageous because it does not require the use of muscle transfer, with minimum donor site morbidity. Success depends on patient selection, coordinated planning with the oncological surgeon and careful intra-operative management.
authors.affiliation: Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine, Brazil. munhozalex@uol.com.br
authors.forename: Alexandre Mendonça
authors.initials: AM
authors.lastname: Munhoz
authors.forename: Eduardo
authors.initials: E
authors.lastname: Montag
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arruda
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Brasil
authors.forename: José Mendes
authors.initials: JM
authors.lastname: Aldrighi
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Filassi
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013524:Surgical Flaps