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The Lateral Intercostal Artery Perforator (LICAP) Flap for Outpatient Total Breast Reconstruction Lee Squitieri MD, MS 1 , Cloe Hakakian BS 2 , Joshua D. Ellenhorn MD 2 , David A. Kulber MD 1,2 , Joel A. Aronowitz MD 1,2 1. Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 2. Plastic and Reconstructive Surgery Center, Cedars Sinai Medical Center, Los Angeles, CA Results Conclusions A single center retrospective chart review of all consecutive patients who received LICAP flaps after mastectomy was performed. A total of 30 flaps were performed in 22 patients between 2005-2013 by two senior surgeons (D.A.K. and J.A.A.) at Cedars Sinai Medical Center. All patients received LICAP flaps in an outpatient setting for delayed total breast reconstruction after prior mastectomy. Data regarding patient demographics, comorbidities, neoadjuvant and adjuvant breast therapies, intraoperative additional procedures, operative time, short term outcomes, and perioperative complications were collected The lateral intercostal artery perforator (LICAP) flap is a reliable, axial skin flap described in previous reports for post-bariatric breast augmentation and chest wall reconstruction. The LICAP flap can produce a large skin paddle without dissection of muscle or fascia and, importantly, it can be performed in an outpatient setting. These features make the LICAP flap useful as an adjunct for total breast reconstruction in patients who are not post-bariatric surgery. We report our experience using this procedure for total breast reconstruction following mastectomy in the outpatient setting. Table 2. Operative Details Figure 1. Operative Dissection of the LICAP Flap Figure 2. Before and After Photos for a Patient with a Radiation Failed Implant Objective A. B. C. D. A. B. C. Objective Table 1. Patient Demographics Parameter The LICAP flap is a practical alternative for total breast reconstruction. It can reliably provide a significant skin paddle even in patients who are not post bariatric surgery without the morbidity, hospitalization, and cost associated with muscle based flaps. These features may result in greater patient acceptance and substantial cost reduction. X of the 30 flaps had undergone a prior reconstruction, X of which were a failed muscle flap X of the 22 patients had an existing prosthesis Patients were followed for a mean follow-up time of 12.5 months. Six flaps (20%) experienced postoperative complications including partial flap necrosis (3), painful donor site keloid (1), and implant infection (2). Parameter

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Page 1: The Lateral Intercostal Artery ... - Los Angeles, CAThe Lateral Intercostal Artery Perforator (LICAP) Flap for Outpatient Total Breast Reconstruction Lee Squitieri MD, MS1, Cloe Hakakian

The Lateral Intercostal Artery Perforator (LICAP) Flap for Outpatient Total Breast Reconstruction

Lee Squitieri MD, MS1, Cloe Hakakian BS2, Joshua D. Ellenhorn MD2, David A. Kulber MD1,2, Joel A. Aronowitz MD1,2

1. Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA2. Plastic and Reconstructive Surgery Center, Cedars Sinai Medical Center, Los Angeles, CA

 

Results

Conclusions

• A single center retrospective chart review of all consecutive patients who received LICAP flaps after mastectomy was performed.

• A total of 30 flaps were performed in 22 patients between 2005-2013 by two senior surgeons (D.A.K. and J.A.A.) at Cedars Sinai Medical Center.

• All patients received LICAP flaps in an outpatient setting for delayed total breast reconstruction after prior mastectomy.

• Data regarding patient demographics, comorbidities, neoadjuvant and adjuvant breast therapies, intraoperative additional procedures, operative time, short term outcomes, and perioperative complications were collected

The lateral intercostal artery perforator (LICAP) flap is a reliable, axial skin flap described in previous reports for post-bariatric breast augmentation and chest wall reconstruction. The LICAP flap can produce a large skin paddle without dissection of muscle or fascia and, importantly, it can be performed in an outpatient setting. These features make the LICAP flap useful as an adjunct for total breast reconstruction in patients who are not post-bariatric surgery. We report our experience using this procedure for total breast reconstruction following mastectomy in the outpatient setting.

Table 2. Operative Details

Figure 1. Operative Dissection of the LICAP Flap

Figure 2. Before and After Photos for a Patient with a Radiation Failed Implant

Objective

A. B.

C. D.

A. B. C.

Objective

Table 1. Patient Demographics

Parameter

Age (years) Mean 64.7 Range 39-83

Body Mass Index (kg/m2) Mean 24.4 Range 18.5-30.5

Smoking History (# of patients) Never 13 Remote 7 Active 2

Prior Mastectomy (# of patients) Unilateral 13 Bilateral 9

Preoperative Radiation (# of patients) Yes 5 No 17

• The LICAP flap is a practical alternative for total breast reconstruction. It can reliably provide a significant skin paddle even in patients who are not post bariatric surgery without the morbidity, hospitalization, and cost associated with muscle based flaps.

• These features may result in greater patient acceptance and substantial cost reduction.

• X of the 30 flaps had undergone a prior reconstruction, X of which were a failed muscle flap

• X of the 22 patients had an existing prosthesis

• Patients were followed for a mean follow-up time of 12.5 months.

• Six flaps (20%) experienced postoperative complications including partial flap necrosis (3), painful donor site keloid (1), and implant infection (2). Parameter

Flap Size (cm2) Mean 260 Range 60-490

Operative Time per Flap (minutes) Mean 171 Range 72-288

Fat Grafting (# of patients) Implant 8 Mastopexy 1 Capsulectomy 8 Symmetrizing Reduction 5 Fat Grafting 15

Page 2: The Lateral Intercostal Artery ... - Los Angeles, CAThe Lateral Intercostal Artery Perforator (LICAP) Flap for Outpatient Total Breast Reconstruction Lee Squitieri MD, MS1, Cloe Hakakian

The Lateral Intercostal Artery Perforator (LICAP) Flap for Outpatient Total Breast Reconstruction

Lee Squitieri MD, MS1, Cloe Hakakian BS2, Joshua D. Ellenhorn MD2, David A. Kulber MD1,2, Joel A. Aronowitz MD1,2

1. Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA2. Plastic and Reconstructive Surgery Center, Cedars Sinai Medical Center, Los Angeles, CA

 

Results

Conclusions

• A single center retrospective chart review of all consecutive patients who received LICAP flaps after mastectomy was performed.

• A total of 30 flaps were performed in 22 patients between 2005-2013 by two senior surgeons (D.A.K. and J.A.A.) at Cedars Sinai Medical Center.

• All patients received LICAP flaps in an outpatient setting for delayed total breast reconstruction after prior mastectomy.

• Data regarding patient demographics, comorbidities, neoadjuvant and adjuvant breast therapies, intraoperative additional procedures, operative time, short term outcomes, and perioperative complications were collected

The lateral intercostal artery perforator (LICAP) flap is a reliable, axial skin flap described in previous reports for post-bariatric breast augmentation and chest wall reconstruction. The LICAP flap can produce a large skin paddle without dissection of muscle or fascia and, importantly, it can be performed in an outpatient setting. These features make the LICAP flap useful as an adjunct for total breast reconstruction in patients who are not post-bariatric surgery. We report our experience using this procedure for total breast reconstruction following mastectomy in the outpatient setting.

Table 2. Operative Details

Figure 1. Operative Dissection of the LICAP Flap

Figure 2. Before and After Photos for a Patient with a Radiation Failed Implant

ObjectiveA. B. C. D.

A. B. C.

Objective

Table 1. Patient Demographics

Parameter

Age (years) Mean 64.7 Range 39-83

Body Mass Index (kg/m2) Mean 24.4 Range 18.5-30.5

Smoking History (# of patients) Never 13 Remote 7 Active 2

Prior Mastectomy (# of patients) Unilateral 13 Bilateral 9

Preoperative Radiation (# of patients) Yes 5 No 17

• Patients were followed for a mean follow-up time of 12.5 months.

• Six flaps (20%) experienced postoperative complications including partial flap necrosis (3), painful donor site keloid (1), and implant infection (2).

• The LICAP flap is a practical alternative for total breast reconstruction.

• It can reliably provide a significant skin paddle even in patients who are not post bariatric surgery without the morbidity, hospitalization, and cost associated with muscle based flaps.

• These features may result in greater patient acceptance and substantial cost reduction.

Parameter

Flap Size (cm2) Mean 260 Range 60-490

Operative Time per Flap (minutes) Mean 171 Range 72-288

Fat Grafting (# of patients) Implant 8 Mastopexy 1 Capsulectomy 8 Symmetrizing Reduction 5 Fat Grafting 15

Page 3: The Lateral Intercostal Artery ... - Los Angeles, CAThe Lateral Intercostal Artery Perforator (LICAP) Flap for Outpatient Total Breast Reconstruction Lee Squitieri MD, MS1, Cloe Hakakian

The Lateral Intercostal Artery Perforator (LICAP) Flap for Outpatient Total Breast Reconstruction

Lee Squitieri MD, MS1, Cloe Hakakian BS2, Joshua D. Ellenhorn MD2, David A. Kulber MD1,2, Joel A. Aronowitz MD1,2

1. Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA2. Plastic and Reconstructive Surgery Center, Cedars Sinai Medical Center, Los Angeles, CA

 

Methods

Results

Conclusions

• A single center retrospective chart review of all consecutive patients who received LICAP flaps after mastectomy was performed.

• A total of 30 flaps were performed in 22 patients between 2005-2013 by two senior surgeons (D.A.K. and J.A.A.) at Cedars Sinai Medical Center.

• All patients received LICAP flaps in an outpatient setting for delayed total breast reconstruction after prior mastectomy.

• Data regarding patient demographics, comorbidities, neoadjuvant and adjuvant breast therapies, intraoperative additional procedures, operative time, short term outcomes, and perioperative complications were collected

The lateral intercostal artery perforator (LICAP) flap is a reliable, axial skin flap described in previous reports for post-bariatric breast augmentation and chest wall reconstruction. The LICAP flap can produce a large skin paddle without dissection of muscle or fascia and, importantly, it can be performed in an outpatient setting. These features make the LICAP flap useful as an adjunct for total breast reconstruction in patients who are not post-bariatric surgery. We report our experience using this procedure for total breast reconstruction following mastectomy in the outpatient setting.

Table 2. Operative Details

Patients were followed for a mean follow-up time of 12.5 months. Six flaps (20%) experienced postoperative complications including partial flap necrosis (3), painful donor site keloid (1), and implant infection (2). The LICAP flap is a practical alternative for total breast reconstruction. It can reliably provide a significant skin paddle even in patients who are not post bariatric surgery without the morbidity, hospitalization, and cost associated with muscle based flaps. These features may result in greater patient acceptance and substantial cost reduction.

Figure 1. Operative Dissection of the LICAP Flap

1A:

1B:

1C:

1D:

Figure 2. Before and After Photos for a Patient with a Radiation Failed Implant

2A:

2B:

2C:

ObjectiveA. B.

C. D.

A. C.B.

Table 1. Patient Demographics

Parameter

Age (years) Mean 64.7 Range 39-83

Body Mass Index (kg/m2) Mean 24.4 Range 18.5-30.5

Smoking History (# of patients) Never 13 Remote 7 Active 2

Prior Mastectomy (# of patients) Unilateral 13 Bilateral 9

Preoperative Radiation (# of patients) Yes 5 No 17

Parameter

Flap Size (cm2) Mean 260 Range 60-490

Operative Time per Flap (minutes) Mean 171 Range 72-288

Fat Grafting (# of patients) Implant 8 Mastopexy 1 Capsulectomy 8 Symmetrizing Reduction 5 Fat Grafting 15