Versatility of Lateral Intercostal Artery Perforator Flaps in Partial Breast Reconstruction: First National Experience of Peru

Objective: Oncoplastic breast surgery (OBS) allows wide oncologic resections without compromising breast symmetry. In small-breasted patients with minimal ptosis, volume displacement techniques have limited applicability. Lateral intercostal artery perforators (LICAP)-based perforator flaps allow immediate or delayed partial breast reconstruction for lateral and central defects, preserving muscle and minimizing donor-site morbidity. This study aimed to evaluate the safety and outcomes of LICAP-based flaps and to report the first national experience in Peru. Materials and Methods: A retrospective observational study was conducted from August 2023 to August 2025 in patients who underwent OBS with perforator-based flap reconstruction, including LICAP, bilobed LICAP, and combined LICAP-lateral thoracic artery perforator (LTAP) flaps. Results: Twenty patients were included. The mean age was 56.8 years (range, 27-81 years), and 65% were postmenopausal. Indications included invasive ductal carcinoma (85%), ductal carcinoma in situ (5%), and phyllodes tumor (10%). Tumor location: upper outer quadrant (65%), central (20%), upper inner quadrant (10%). Clinical stage IIA was the most frequent (55.5%), and tumors measuring 3-4 cm were observed in 45% of cases. Luminal B was the predominant subtype (40%), and 35% of patients received neoadjuvant chemotherapy. Procedures included bilobed LICAP (35%), LICAP+LTAP (30%), and LICAP (25%). The mean operative time was 134 minutes (range, 90-195 minutes), and the mean pathological tumor size was 3.57 cm (range, 0-7 cm). Negative margins were achieved in 95% of patients. Surgical complications (Clavien-Dindo grade I) occurred in 15%. During a median follow-up of 22.5 months (range, 10-24 months), no locoregional recurrences were observed. Conclusion: LICAP-based volume replacement OBS is a versatile, safe, and reproducible technique that may expand the indications for breast-conserving surgery in selected patients and yields encouraging short-term outcomes comparable to those reported in international series.