Subutilización de los colgajos perforantes en cirugía oncoplástica: análisis clínico y barreras terminológicas

Abstract

Objective

To evaluate the safety, efficacy, and esthetic outcomes of chest wall perforator flaps in breast-conserving surgery and to analyze the terminological barriers affecting their adoption.

Materials and methods

A retrospective observational study was conducted on 27 patients treated between 2020 and 2024 with breast-conserving surgery and partial breast reconstruction using perforator flaps of the lateral intercostal artery (LICAP, Lateral Intercostal Artery Perforator), lateral thoracic artery (LTAP, Lateral Thoracic Artery Perforator), and medial intercostal artery (MICAP, Medial Intercostal Artery Perforator). Clinical variables, flap selection, complications, and esthetic outcomes were analyzed using the Harvard Scale. Follow-up included immediate postoperative assessment and evaluation at one year.

Results

A total of 85.2% of patients achieved good or excellent esthetic outcomes, with no changes in Harvard Scale scores at one year. No patient requested symmetry surgery. Eight complications were reported (29.6%), mostly minor (seromas, hematomas, partial fat necrosis), all managed conservatively. One case of flap necrosis required mastectomy. No surgical site infections or wound dehiscence were documented. The complication rate and esthetic success were comparable to international series.

Conclusion

Chest wall perforator flaps represent a safe and effective option in breast-conserving surgery, with low morbidity and excellent esthetic acceptance. The lack of consensus in nomenclature remains a barrier to widespread adoption. Standardization and structured training programs are essential to optimize their clinical application.