Chest wall perforator flaps for partial breast reconstruction: An observational cohort study of 290 women to evaluate clinical and oncological outcomes

Background Partial breast reconstruction (PBR) using chest wall perforator flaps (CWPFs) is an oncoplastic technique utilised to facilitate breast conservation surgery (BCS). It is particularly applicable in women with a larger tumour-to-breast volume ratio requiring volume replacement rather than volume displacement. This single-centre retrospective cohort study aimed to explore the safety and efficacy of PBR using CWPFs. Method All patients who underwent PBR using a CWPF following wide local excision between March 2016 and August 2024 were reviewed. Data was extracted from hospital electronic patient records and statistical analysis performed using R-Studio® (alpha = 0.05). Results Of 290 cases identified: 237 had invasive cancers and 53 ductal carcinoma in situ (DCIS). The median age at presentation was 59 years and the median tumour size 22 mm, with multifocal tumours in 22.1 % of cases and extensive DCIS in 27.0 % of invasive cancers. Overall, complication rates were low (n = 83, 28.6 %) with 6.9 % of patients requiring a return to theatre. Margins were involved in 17.8 %, with 15.6 % requiring re-excision. The locoregional recurrence (LRR) rate was 2.9 % and disease-free survival (DFS) 93.8 % with a median follow-up of 3.1 years (n = 276). A subset analysis of women receiving surgery before January 2020 (n = 96) with a follow-up of 5.1 years had a LRR of 4.2 %. Conclusion This study reports acceptable rates of complications, margin re-excision and LRR, demonstrating the safety and efficacy of utilising PBR with CWPFs for the treatment of breast cancer. CWPFs offer the opportunity to extend the boundaries of BCS to those women who may otherwise require a mastectomy.