Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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The Lateral Intercostal Artery Perforator (LICAP) Flap for Outpatient Total Breast Reconstruction
Lee Squitieri, M.D.1, Cloe Hakakian, B.S.2, Joshua D.I. Ellenhorn, M.D.2, David Kulber, M.D.3, Joel A. Aronowitz, M.D.4.
1University of Southern California, Los Angeles, CA, USA, 2Cedars Sinai Medical Center, Los Angeles, CA, USA, 3University of Southern California, Cedars Sinai Medical Center, Los Angeles, CA, USA, 4Cedars Sinai Medical Center, University of Southern California, Los Angeles, CA, USA.

Title
The Lateral Intercostal Artery Perforator (LICAP) Flap for Outpatient Total Breast Reconstruction
Abstract
Purpose: 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.
Methods: A single center retrospective review of 25 LICAP flaps in 19 patients was performed. All patients received LICAP flaps in an outpatient surgery setting for delayed total breast reconstruction after prior mastectomy.
Results: A total of 25 flaps for total breast reconstruction were performed in 19 patients with a mean operative time of 2.24 hours per breast. 23 of the 25 flaps had undergone a prior reconstructive attempt, 3 of which were a failed muscle flap reconstruction. 17 of the 19 patients had an existing prosthesis. Four of the 19 patients had prior radiation therapy and the mean body mass index was (23.7, range 18.3-35.0). Flap dimensions ranged from 6 x 12cm to 16 x 28cm (mean 9.9 x 23.7cm). Concurrent surgery included fat grafting (15 breasts), implant placement (10 breasts), mastopexy (1 breast), capsulectomy (6 breasts), symmetrizing reduction (4 breasts). Patients were followed for a mean follow-up time of 12.5 months, and 4 flaps (16%) experienced post-operative complications including partial flap necrosis (2), painful donor site keloid (1), and implant infection (1).
Conclusion: 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 greater patient acceptance and substantial cost reduction.
Table 1. Patient Demographics
Parameter
Age (years)
Mean63.3
Range39-83
Body Mass Index
Mean23.7
Range18.5-30.5
Prior Mastectomy
Unilateral12
Bilateral7
Preoperative Radiation
Yes4
No15

Figure 1a
Figure 1c
Figure 1b
Figure 1d
Figure 1 shows the operative dissection of the LICAP flap
Figure 2a
Figure 2b
Figure 2c
Figure 2 shows before and after photos for a patient who had a radiation failed implant
Figure 3a
Figure 3b
Figure 3c
Figure 3 shows before and after photos of a patient who had LICAP flaps and implants



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