Types of oncoplastic breast-conserving surgery: LICAP flap

Oncoplastic reconstructive techniques in breast-conserving surgery plans for treating breast cancer combine plastic surgery methods with tumour removal so that patients can retain their breasts’ natural shape and feel. Oncoplastic reconstructions achieve excellent cosmetic and aesthetic results, as well as high rates of patient satisfaction and long-term efficacy.

There are several innovative oncoplastic breast reconstruction options available today, including the LICAP flap procedure, a volume replacement method that uses the patient’s natural autologous tissue to rebuild the breast and fill in the defect following the removal of the tumour. This guide will explain this surgical approach in more detail, including its benefits and limitations, and who would be considered a suitable candidate for this kind of operation.

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What is LICAP flap surgery?

‘LICAP’ stands for lateral intercostal artery perforator. This is an area of skin and tissue supplied with blood by the lateral intercostal artery on the side of the torso beneath the armpit area. In LICAP flap surgery, this area of tissue is removed and transplanted to the breast to reconstruct it. Only skin and fat is used, and since muscles in the area are untouched, movement and strength in the shoulder and arm are unaffected.

LICAP flap breast surgery is a great alternative to total mastectomy in instances where cancer tumours are located on the outside portion of the breast and a standard lumpectomy would cause substantial deformities in the affected breast.

When a tumour is removed from the breast, surrounding tissue is usually also taken away and this can cause the breast to look misshapen and asymmetrical. Oncoplastic techniques such as the LICAP flap reconstruction avoid this type of deformity. Stephen McCulley is an expert in oncoplastic breast surgery and he is able to perform this partial breast reconstruction procedure at the same time as a lumpectomy so that the patient does not need to endure two operations.

What are the benefits of LICAP flap surgery?

Similar to other oncoplastic surgery techniques, there is a high satisfaction rate amongst patients who undergo LICAP flap surgery. One of the biggest benefits of this breast cancer surgery technique is that the tumour is removed and the breast reconstructed in one procedure. Not only does this make the recovery process smoother, but many patients also find this easier to deal with from an emotional and mental perspective.

Compared to other breast reconstructive procedures which involve the transplant of muscle in addition to skin and fat, LICAP flap surgery does not cause problems with strength and movement. Furthermore, the scarring is less extensive than other methods and depending on the position of the excision will be mainly hidden beneath the bra and under the arm when it is at rest.

Many women prefer to maintain as much of their own breast tissue as possible in order to avoid having a total breast reconstruction. With a LICAP flap reconstruction, breast volume and sensation can be retained while also achieving excellent aesthetics and symmetry.

What are the limitations of LICAP flap surgery?

There are some limitations to LICAP flap surgery and, as with any other surgical procedure, it does not come without risks. This is an operation requiring anaesthesia, which can cause side effects such as nausea and vomiting. Patients also tend to experience some pain, tenderness, swelling and bruising around the surgery site.

If the surgeon is not able to find a suitable blood vessel from which to transplant tissue, LICAP flap surgery will not be able to take place but this is uncommon. It is also important to note that radiotherapy might cause some shrinkage of the breast following a lumpectomy and LICAP flap reconstruction, which could impact the final symmetry of the breast. Most patients are advised to have radiotherapy as part of their breast cancer treatment when using a lumpectomy, so this is something to consider.

Like any intensive surgery, there are some potential complications associated with the LICAP flap reconstruction that you should be aware of. One such complication is infection of the wound, which is rare and can usually be treated easily with antibiotics. Delayed wound healing is another uncommon occurrence, and this can require further surgery to repair skin separation. Other rare complications include:

Haematoma – this is where bleeding occurs in the tissues after surgery.
Deep vein thrombosis (blood clots) – this is managed well with compression garments.
Seroma (a build-up of fluid under the skin at the surgery site) – this is a normal occurrence following surgery and is nothing to worry about. However, in rare cases, patients can experience unusually high volumes of seroma which is uncomfortable and may require draining, although this process is simple and painless.
Perforator flap failure or loss – this is where the transplanted tissue dies due to a problem with blood supply.
Fat necrosis – this is when fat cells lose blood supply and die off. In this case, the tissue does not need to be removed but it can make the area feel firm and lumpy.

Who is a good candidate for LICAP flap surgery?

LICAP flap surgery may be recommended as an option to patients with early-stage breast cancer where the tumour is located on the outside (lateral) portion of the breast. Patients should also be of a healthy weight. Those who are underweight may not have enough fat and tissue available to reconstruct the breast.

Patients who are overweight and/or a smoker are more likely than non-smokers and patients of a healthy weight to experience the surgery risks mentioned in the previous section. It is therefore recommended that if you are considering the LICAP flap or any other oncoplastic surgery that you lose weight and stop smoking before your operation, to reduce the risk of complications.

If you think that you would be a suitable candidate for LICAP flap surgery or would like to discuss alternative oncoplastic reconstruction methods, please contact the Stephen McCulley team to arrange a consultation.

Frequently asked questions

What is a perforator in oncoplastic breast surgery?

Perforators are the small blood vessels that support areas of skin and fat taken from the underarm area to reconstruct the breast following lumpectomy.

What is a pedicle in oncoplastic breast surgery?

A pedicled reconstruction will use areas of tissue often taken from the back or abdomen to reconstruct the breast following lumpectomy. This tissue remains connected to the blood flow from the artery used for the reconstruction. The TDAP flap is an example of a pedicled perforator flap reconstruction method.

What is the difference between LTAP flap and LICAP flap surgery?

LTAP flap and LICAP flap surgeries are very similar; they simply involve different areas of tissue in the underarm area. LTAP flap surgery uses tissue from the lateral thoracic artery perforator, sometimes called the thoracodorsal artery perforator. LICAP flap surgery uses tissue from the lateral intercostal artery perforator.

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