Lateral Intercostal Artery Perforator (LICAP) Flap

Breast-conserving surgery followed by radiotherapy is favoured for early-stage breast cancer or downstaged patients after neoadjuvant chemotherapy. However, often partial tumour resection may deliver an unpleasant cosmetic outcome, notably when more than 20% of the breast tissue is excised. As a result, breast-conserving surgery evolved to oncoplastic surgery by broadening its general indication to achieve wider excision margins without jeopardising the aesthetic results. Over the decades, the development of oncoplastic surgery increased the number of techniques available, matching the right candidate for the proper procedure based on tumour characteristics, breast size and location of the tumour. Oncoplastic techniques for a high tumour-to-breast ratio can be classified into volume displacement or volume replacement procedures. The latter requires tissue replacement inside the tumour excision defect from a regional or distant site. Amongst several volume replacement techniques, the local lateral intercostal artery perforator flaps are associated with low morbidity and better aesthetic outcome. In 2004, Hamdi et al. were the first to describe the lateral intercostal artery perforator (LICAP) flap (Hamdi et al., Br J Plast Surg 57:531–539, 2004). From the beginning, this technique was employed for breast reconstruction. Nowadays, partial breast reconstruction with LICAP flap is an emerging technique for patients with a high tumour-to-breast ratio primarily located at the outer quadrants of the breast. This volume replacement oncoplastic procedure is ideally offered for patients with small to moderate-sized breasts without the necessity for symmetrisation. The replacement procedure with the LICAP flap expanded the indications for breast-conserving surgery in patients otherwise be offered a mastectomy, which has its known implication onto the women’s mental and physical well-being.