Breast reconstruction techniques with perforator flaps vs other surgical techniques in breast cancer

Abstract

Introduction: Chest wall perforator flaps are increasingly used as volume replacement techniques in breast-conserving surgery for patients with unfavorable tumor-to-breast ratios or limited remodeling capacity. Their oncologic safety and complication profile compared to other standard techniques remain under evaluation.

Methods: We conducted a retrospective comparative observational study of 346 patients undergoing breast cancer surgery between 2020 and 2024. Patients were divided into 4 groups: chest wall perforator flap reconstruction (n = 36), lumpectomy without reshaping (n = 161), lumpectomy with oncoplastic mammoplasty (n = 69), and mastectomy with or without immediate reconstruction (n = 80). Surgical complications were classified using Clavien-Dindo. Re-excision rates, local recurrence, and patient satisfaction (BREAST-Q) were evaluated.

Results: Chest wall perforator flap patients had a complication rate of 11.1%, comparable to lumpectomy (11.8%) and oncoplastic mammoplasty (11.6%), and lower than mastectomy with reconstruction (23.1%). The re-excision rate in chest wall perforator flap was 13.9%, compared with 19.3% in lumpectomy and 17.4% in oncoplastic cases. No local or distant recurrences were observed in chest wall perforator flap patients during a mean follow-up of 21.4 months. Patient satisfaction in the chest wall perforator flap group was high, with 86.1% reporting favorable cosmetic outcomes.

Conclusions: Chest wall perforator flap reconstruction offers complication and re-excision rates comparable to other surgical techniques, with excellent short-term oncologic safety and high patient satisfaction. They are a valuable option for selected patients undergoing breast-conserving surgery, particularly when tumor size or location limits the use of standard approaches.