020 3433 2131
breastsurgeoninlondon@gmail.com

Perforator Artery Flaps – Case Study 3
Patient with a large left breast cancer in the outer part of her breast.
  • This 63-year-old woman presented with a right upper outer quadrant 46mm (on ultrasound) breast cancer (BB). Biopsy showed Grade 2 Invasive Ductal Carcinoma, ER +ve, PR+ve, HER2-neg. Axillary Lymph node fine needle aspiration showed cancer spread to the axillary lymph nodes. Staging CT scan showed no distant metastasis. Based on these results, the multi-disciplinary meeting recommended that this patient proceeded to surgery first.

  • As the BC was large-sized in relation to her breast size (38D) , a lumpectomy alone would require removal of at least 1/3rd of the patient breasts leaving significantly poor cosmetic results and asymmetry.  Fortunately, there was enough excess fat tissue below her right armpit (axilla)  which was used as a perforator flap. I performed a Doppler flow ultrasound showed easily identifiable and large-sized LICAP and Lateral Thoracic Arterial Perforator (LTAP) vessels supplying the harvest site.

  • At the operation, I performed a lumpectomy (122 g of breast tissue including the BC tumour) and a level 1 to 3 axillary clearance. At the same time, I harvested a triangular -shaped flap from the fat-skin tissue below the axilla. The LICAP and LTAP vessel were identified during the operation and carefully preserved. The flap was rotated into the cavity left behind by the lumpectomy. Skin was closed and dressed with a special vacuum PICO dressing to accelerate wound healing.

  • Post-operatively, the histology showed 55mm Grade 2 Invasive ductal carcinoma with high grade DCIS(60mm in total) with clear margins. Out of the 17 lymph nodes removed, 3 had cancer in them.

  • Post-operatively, the wound healed uneventfully and subsequent doppler flow ultrasound showed good flow in the LICAP and LTAP vessels (video attached). Patient was advised to moisturise and massage the right breast regularly to reduce scarring, hardness and pain.

  • After surgery, the patient required chemotherapy, radiotherapy to the right breast and then started on Letrozole.

  • As of May 2024, the patient’s wound has healed  and the scar barely visible. There are no restrictions to the patients right should mobility and she does not report of any pain in breast or below the axilla. There was no signs of BC recurrence.

If you would like to make an appointment to see Mr Chong, please contact his Personal Assistant