Chest Wall Perforator Flaps in Breast Conservation: Versatile, Affordable, and Scalable: Insights from the Largest Single-Surgeon Audit from India

Abstract

Chest wall perforator flaps (CWPFs) are a promising option for partial breast reconstruction but are underutilized, particularly in resource-limited settings. This retrospective observational study explores the feasibility and impact of CWPFs in breast-conserving surgery at our single-surgeon center, where 203 procedures were performed between 2018 and 2023. We evaluate 200 cases treated after multidisciplinary tumor board discussions and shared decision-making, assessing clinicopathological data, surgical outcomes, oncological results, cosmetic outcomes, and patient-reported outcome measures (PROMs). The median age of patients was 52.5 years. Single CWPFs were used in 75.9% and dual flaps in 24.1%. Sentinel node biopsy was performed in 76.9% of malignant cases, with no positive margins. Minor complications occurred in 11%, and no major complications were reported. At a 27-month median follow-up, the overall survival rate was 97.5%, with a disease-free survival of 92.1%. Cosmetic outcomes were good-to-excellent, and PROMs indicated high satisfaction. This largest single-surgeon study from Asia demonstrates the transformative role of CWPFs in breast conservation surgery for Indian women with sizable, locally advanced tumors. The technique offers excellent oncological and cosmetic outcomes, reduced costs, and a shorter operative time, highlighting the need for oncoplastic algorithms in resource-limited settings to improve breast conservation accessibility.