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

Background: Local flaps for breast reconstruction are becoming recognized as a viable alternative to remote flaps.

Objectives: The purpose of this manuscript is to describe the anatomy and clinical outcomes using the internal mammary artery perforators and the 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 5th intercostal space. Twenty-two patients had partial or total breast reconstruction using the internal mammary artery perforator flaps that was combined with the lateral intercostal artery perforator flap in 4 patients. The study was performed at the Hospital de Clinicas Jose de San Martin that is affiliated with the Universidad de Buenos Aires in Argentina between March 2018 -December 2023. Outcomes were based on clinical evaluation and statistical analysis. Patient satisfaction was assessed on a 5-point Likert scale based on whether they 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 two patients. Minor complications included a small hematoma and a minor wound dehiscence. Patient satisfaction was rated as very good or excellent in 100% of women when clothed and rated as good to very good in 93.3% of women 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 can be successfully used for partial or total breast reconstruction in properly selected patients.