title: Lateral Intercostal Artery Perforator Flap in Breast Reconstruction: A Simplified Pedicle Permits an Expanded Role.
abstract: BACKGROUND
  The lateral intercostal artery perforator (LICAP) flap is a versatile second-tier option in breast reconstruction. The flap is rotated from redundant lateral chest fold on an easily dissected skin bridge pedicle without microsurgery in an outpatient setting. This series illustrates safety and effectiveness of the LICAP flap for prosthesis coverage when a muscle flap is not available or desired. In some cases, it even provides adequate soft tissue to reconstruct the breast mound without an implant.
  
  
  METHODS
  Lateral intercostal artery perforator flaps performed for breast reconstruction at an ambulatory surgery center were reviewed.
  
  
  RESULTS
  A total of 39 flaps were performed on an outpatient basis for a variety of breast reconstruction indications. One immediate reconstruction with bilateral LICAP flaps was performed after mastectomy. All remaining flaps were for delayed breast reconstruction. Mean operative time for each flap was 65 minutes, and concomitant procedures were performed in 25 of 27 patients. Follow-up was 5 to 96 months. There was 1 major complication (2.5%) and 5 minor (12.8%) complications.
  
  
  CONCLUSIONS
  This series demonstrates unique advantages of the LICAP flap for a variety of breast reconstruction problems, including outpatient setting, no muscle sacrifice, flap reliability, and low donor site morbidity. These results confirm previous reports in post bariatric augmentation that the LICAP flap reliably supplies a large skin/adipose flap from the redundant tissue of the lateral chest fold with minimal morbidity even after radiation. The LICAP flap warrants closer consideration in breast reconstruction.
authors.affiliation: From the *Department of Research, University Stem Cell Center; †Keck School of Medicine, University of Southern California; and ‡Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Cloe S
authors.initials: CS
authors.lastname: Hakakian
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Lockhart
authors.forename: David A
authors.initials: DA
authors.lastname: Kulber
authors.forename: Joel A
authors.initials: JA
authors.lastname: Aronowitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061525:Perforator Flap / Q000098:blood supply; D012189:Retrospective Studies; D012272:Ribs / Q000098:blood supply