EP 249 Outcomes Following Chest Wall Perforator Flap Surgery: Eight-Year Experience at the Leeds Breast Unit
Rhian Morgan, Wasif Tahir, Hamza Ikram, Brian Hogan, Baek Kim, Raj AchuthanAbstract
Introduction
Chest wall perforator flap (CWP) provides volume replacement to cover defects post breast conserving surgery (BCS). It aims to reduce mastectomy rates and minimise the need for contralateral symmetrising surgery.
Methods
This is a retrospective cohort study which analysed outcomes of CWP flap surgery (January 2017-December 2024) performed at the Leeds Teaching Hospitals NHS Trust. Clinical outcome data were collected using an electronic health record system, Patient Pathway Manager (PPM). Simple summary statistics were calculated to describe demographic and outcome data.
Results
In total, 81 patients (median age of 56 years) underwent 82 CWP flap surgery. Histological subtypes included invasive ductal (59.8%), invasive lobular (14.6%), and ductal carcinoma in-situ (14.6%) with a median radiological tumour size of 26mm (IQR 20-35). Multifocal cancers were present in 8.4% of patients. LICAP flaps were the most prevalent (70%), followed by LICAP and LTAP (10%), MICAP (7%), AICAP (7%), and LTAP (6%). CWP flaps were utilised to cover defect post-BCS (87.8%), post-margin re-excision (7.3%), and post-mastectomy reconstruction (4.9%). The 30-day Clavien-Dindo complication rates were 17.1% (grade 2) and 2.4% (grade 3). Flap failure rate was 0. Involved margins were seen in 8.5% of patients with 1.2% eventually requiring mastectomy. With a median follow-up of 32 months, local recurrence rate was 4.9% with distant metastases rate of 3.6%. No patients required contralateral symmetrising surgery.
Conclusions
Chest wall perforator flaps are associated with low morbidity, low local recurrence rate, and low revisional surgery rate. This increases the range of indications for breast conserving surgery.