Background: Breast conservation therapy for breast cancer continues to evolve and often includes significant lumpectomy defects that can be reconstructed to achieve an aesthetically pleasing breast mound. The intercostal artery perforator (ICAP) flaps have emerged as an option for breast conservation after extensive post-lumpectomy defect reconstruction. Since this is a relatively new procedure, we present our institution’s experience in evaluating the post-operative breast after ICAP reconstruction in this educational exhibit, which can present a diagnostic challenge for breast radiologists.
Learning Objectives: 1. Understand the role of ICAP flaps in post-lumpectomy breast reconstruction. 2. Observe the post-surgical results in patients who have undergone the procedure. 3. Identify key imaging features of ICAP flaps post-reconstruction by mammography, ultrasound, and MRI. 4. Differentiate between normal post-surgical changes, ICAP flap appearance, and potential recurrence.
Abstract Content/Results: Introduction. Anatomical details. ICAP flap reconstruction following large lumpectomy defects offers a promising functional and aesthetic breast restoration solution. Mammography plays a crucial role in assessing breast tissue. ICAP flaps typically appear as well-defined fat-containing soft tissue masses. Understanding their mammographic appearance is vital in distinguishing the flap from suspicious findings. Ultrasound provides real-time imaging, aiding in evaluating potential complications like seroma formation. ICAP flaps typically exhibit a homogeneous echogenicity with a subcutaneous fat layer. MRI offers comprehensive visualization of the reconstructed breast, helping assess flap viability and potential complications. ICAP flaps typically appear as enhancing soft tissue structures on contrast-enhanced MRI, with a characteristic vascular pattern. Post-reconstruction patient appearances. Conclusion.
Conclusion: Breast radiologists should comprehensively understand the anatomy, imaging modalities’ appearance and their role in the postoperative assessment of patients undergoing breast reconstruction with ICAP flaps. ICAP flaps provide breast conservation options in patients who require large lumpectomies to achieve optimal aesthetic outcomes, allow for safe radiation therapy, and avoid mastectomy. Radiologists' familiarity with the imaging appearance of ICAP flaps and their potential overlap with post-surgical changes is critical to prevent unnecessary additional imaging evaluation. By understanding mammography, ultrasound, and MRI appearances of the ICAP flap reconstruction, radiologists can contribute significantly to accurately assessing the post-surgical breast.