Abstract: The last decade there is an increasing interest in immediate partial breast reconstruction (BR) with volume replacement techniques using local perforator flaps from the chest wall or the upper abdomen. With this method, many women diagnosed with breast cancer can avoid mastectomy with very good aesthetic outcomes. CWPF can be utilized even in total breast reconstruction, when patients are deemed unsuitable for the other, well-described reconstructive techniques.

Methods: between July 2022 and November 2024, 50 cases of BR based on CWPF were performed . Of those cases, 5 patients underwent immediate total BR after skin or nipple sparing mastectomy. The rest were women treated with wide local excision for uni- or multifocal or multicentric breast cancer (invasive and/or in situ). Mean age of the patients was 56 years old. Most patients had small to medium breasts (A to D cup breasts). LICAP (lateral intercostal) and LTAP (Lateral Thoracic) were the flaps most frequently used. AICAP (Anterior Intercostal) was considered the most proper option for lower quadrant tumors. TDAP (Thoracodorsal) is considered the most challenging perforator to dissect and it was used in one case of total breast reconstruction.

Discussion: CWPF is an excellent method of reconstructing sizeable breast defects, which, otherwise, would require mastectomy. With this method, breast surgeons can perform lumpectomies with wider margins and better cosmesis. The most ideal candidates are women with small/medium breasts and a degree of lateral chest wall laxity. The method is of low cost (compared to mastectomy and total BR) and leads to higher patient’s satisfaction. We believe that CWPF can be a new alternative even in total BR.

Conclusion: Volume replacement techniques with perforator flaps is a new tool that every modern oncoplastic breast surgeon should be able to offer to his/her patients.