FLAP RECONSTRUCTION SURGERY (AUTOLOGOUS RECONSTRUCTION) - LICAP FLAP, LTAP FLAP, AICAP FLAP, TDAP FLAP

Breast-conserving surgery (BCS) aims to resect breast cancer lesions while preserving the breast’s shape. However, the amount of tissue excised during BCS significantly impacts both cosmetic out-comes and patient satisfaction. Traditionally, patients with large resections were advised to undergo mastectomy to avoid breast deformity. Oncoplastic surgery has expanded the possibility of breast con-servation, using volume replacement techniques or volume displacement techniques, through volume replacement techniques using chest wall perforator flaps, which have been especially beneficial for patients with small to moderate-sized breasts. These techniques not only offer superior aesthetic results but also play a crucial role in improving the patient’s quality of life by addressing potential breast deformities. The volume replacement approach involves the use of adipofascial tissue surrounding the breast, which is recycled and transferred to restore defects after resection. Flaps that harvested from areas in the submammary line, such as thoracic-epigastric perforator flaps, are commonly used for reconstruction, while lateral chest wall perforator flaps, such as the lateral intercostal artery perforator (LICAP), lateral thoracic artery perforator (LTAP), and thoracodorsal artery perforator (TDAP) flaps, are employed for upper and lateral breast excisions. These oncoplastic techniques eliminate the need for mastectomies or prosthetic implants, significantly reducing complications and improving cosmetic outcomes. The success of perforator flaps depends on the identification of suitable perforators with a reliable blood supply, identified accurately preoperatively by Doppler ultrasound. Perforators are clas-sified into musculocutaneous and septocutaneous types, and their precise location detection intraopera-tively is critical for successful flap harvest and consequently flap viability. Pedicled local flaps offer the advantage of preserving underlying muscle tissue, reducing donor-site morbidity, and ensuring the aes-thetic similarity of the transferred tissue. Proper preoperative planning is essential, including the iden-tification of the tumor site, anticipated defect size, and flap design, to prevent volume mismatches and ensure optimal results. Flap transfer techniques, such as the propeller and turnover methods, depend on the size and location of the defect and skin replacement requirments. Careful dissection, preservation of multiple perforators when possible, and gentle handling of the flap during harvest and transfer are vital to minimizing complications. These advances in oncoplastic surgery provide an effective and aesthetic solution for breast cancer patients, enhancing both functional and psychological recovery.