Chest Wall Perforator Flaps in Oncoplastic Breast Surgery: A Series of 157 Consecutive Cases at the Paris Breast Center.

Abstract

Background: Chest wall perforator flaps (CWPF) are emerging as a versatile and safe oncoplastic technique for breast-conserving surgery, particularly in small to medium breasts and challenging tumor locations. Despite proven benefits, their adoption remains limited by the lack of long-term real-world data.

Methods: A single-institution retrospective analysis was conducted to assess CWPF outcomes in 157 patients with early-stage breast cancer treated at the Paris Breast Center between 2005 and 2024. Primary outcomes were complication rates, re-excision, and conversion to mastectomy rates. Secondary outcomes included local and distant recurrence, and overall survival with median follow-up exceeding 4 years.

Results: The median age was 60 years; most tumors were cT1-T2 with median size 14.4 mm. CWPF types were anterior intercostal artery perforator (AICAP; 70.7%), lateral intercostal artery perforator (LICAP; 18.5%), LICAP + lateral thoracic artery perforator (LTAP; 6.4%), and LTAP (4.5%). Early complications (grade ≥II) occurred in 5.1% with no partial or total flap loss. The rate of re-excision was 5.7% and of completion mastectomy was 0.6%. The median follow-up was 48 months; local recurrence occurred in 2.5% and distant recurrence in 6.4%, with no deaths.

Conclusions: CWPF reinforces the evolving role of oncoplastic surgery in safely extending breast-conserving opportunities, including neoadjuvant systemic therapy and re-operative settings. Prospective, multicentric studies including patient-reported outcomes are warranted to further validate these findings.