The IMAP and MICAP Flaps for Autologous Breast Reconstruction: An Anatomic, Clinical, and Outcome Study

Abstract Background Local flaps for breast reconstruction are becoming recognized as a viable alternative to remote flaps. Objectives The purpose of this article was to describe the anatomy and clinical outcomes of internal mammary artery perforators and lateral intercostal artery perforator flaps for breast reconstruction. Methods Twelve cadaveric specimens were injected with colored latex and dissected to demonstrate the medial perforators of the fifth intercostal space. Twenty-two patients had partial or total breast reconstruction with internal mammary artery perforator flaps, which were combined with lateral intercostal artery perforator flaps in 4 patients. The study was performed at the Hospital de Clinicas Jose de San Martin, which is affiliated with the Universidad de Buenos Aires in Argentina, between March 2018 and December 2023. Outcomes were based on clinical evaluation and statistical analysis. Patient satisfaction was assessed on a 5-point Likert scale based on whether patients were clothed or unclothed. Results All flaps survived without any evidence of partial flap necrosis. There were no major complications (total flap loss, partial necrosis); however, fat necrosis was demonstrated in 2 patients. Minor complications included a small hematoma and a minor wound dehiscence. Patient satisfaction was rated as very good or excellent in 100% of females when clothed and rated as good to very good in 93.3% of females when unclothed. Conclusions Submammary perforator flaps can be raised on numerous vascular pedicles. This study has demonstrated that the internal mammary and the lateral intercostal perforators can be successfully utilized for partial or total breast reconstruction in properly selected patients. Level of Evidence: 4 (Therapeutic)