Local Perforator Flaps in Oncoplastic Breast Surgery: Clinical Applications of ICAP and TDAP Flaps in Reconstruction and Complication Management.

Introduction: Local perforator flaps have become an increasingly important option in oncoplastic breast surgery. Despite their long-standing use, their application in clinical practice remains limited. This study evaluates the use of thoracic wall perforator flaps, specifically the intercostal artery perforator (ICAP) and thoracodorsal artery perforator (TDAP) flaps, for volume and skin replacement after breast-conserving therapy and in the management of complications following reconstructive procedures. Materials and Methods: We performed a retrospective analysis of 50 patients treated with local perforator flaps between March 2022 and March 2025 at the Interdisciplinary Breast Center, Klinikum rechts der Isar. Follow-up examinations were conducted in a standardized manner by the primary surgeon and included clinical and ultrasound assessments of the flap, as well as documentation of complications, perfusion, and patient-reported outcomes. Results: ICAP flaps were used in 39 cases and TDAP flaps in 11 cases. The majority of reconstructions (72%) were immediate. ICAP flaps were mainly used for lower and central defects, whereas TDAP flaps were used for upper outer quadrant and complex cases. The mean operative time was 109 minutes, longer for TDAP flaps (153 minutes). There was no total flap loss and complications were rare (one partial necrosis, three seromas). Radiotherapy was administered in 72% of cases without flap compromise. Flaps were also effective in the management of implant-related or autologous reconstruction complications. Discussion: Perforator flaps offer reliable, low morbidity reconstruction options with good aesthetic outcomes and low complication rates, even after radiotherapy. They are also suitable for secondary reconstruction and management of complications. Conclusion: Local perforator flaps, particularly ICAP and TDAP, are safe, versatile tools in oncoplastic breast surgery and should be more widely considered in clinical practice.