Lateral intercostal artery perforator (LICAP) Flap breast reconstruction

Lateral Intercostal Artery Perforator (LICAP) flap breast reconstruction is suitable for some patients whose breast cancer is in the outer part of the breast. The procedure aims to replace the lost breast tissue (removed at the time of cancer surgery) with skin and fat from under your arms and restore the size and shape of your breast.

What happens during LICAP?

You will be admitted on the morning of your surgery. Your surgeon will draw on you to indicate where the incisions (cuts) will be and explain where you will have scars after the operation. They will use a piece of equipment called a hand-held Doppler to map out the underlying blood vessels, which will supply blood to the flap/tissue being moved to fill the defect in your breast.

Photographs are often taken prior to and after the operation for records and comparison. These will be from your neck down and will be anonymous. You will be asked to sign a consent form to show that you are happy for this to happen.

The operation usually takes 1-2 hours. Tissue from under your arms will be used to reconstruct the space left in your breast after your tumour has been removed. No muscle is removed in this operation, meaning there is no affect to how your arm or chest will move.

You will have quite a long scar on the side of your chest wall going towards your back. All the surgery on your breast, including lymph nodal surgery (if required) will be performed through the same scar. Therefore, there won’t be any scar on the breast (except in some cases where it may be necessary to remove the skin on the breast if the underlying cancer is close to the skin).

You may have wound drains in place for a short time after your surgery. The wound is closed by dissolvable stitches under the skin with either surgical “glue” or paper "stitches" known as steri-strips to the skin.

Severe discomfort following LICAP is uncommon. The nurse will ask you about your pain and provide pain relief to meet your needs. It is advisable to have some paracetamol at home should you need it. However you will be given some pain relieving medication and advice before you are discharged.

The day after your operation you should feel more independent and you will be shown some gentle arm exercises to maintain your shoulder mobility. A nurse will give you an information booklet about these exercises to help you to remember what to do when you go home.

Going home after LICAP

The typical stay in hospital is 1-2 days with a recovery period at home of approximately 3-4 weeks.

Your scar may feel tight to start with but it tends to relax within a few weeks. You should do the gentle exercises to ensure you regain a complete range of shoulder movement within 1-2 weeks.

Wear a soft breast support (e.g. a vest) for the first week. You could then change to a soft non-wired bra for a further few weeks (3-4 weeks).

You will need to sleep on your back for 2 weeks. Driving is best avoided for the first 1-2 weeks and normal strenuous activities can be resumed after 4-6 weeks to allow wound healing.

The length of time you need to take off work depends on the nature of your job but you will need to plan for at least two to four weeks. The swelling and bruising subside in a few weeks but it can take 6-12 months for the scars and shape of the breasts to settle.

Most women are pleased with the results of their surgery. As with any surgical procedure there may be complications including:

• Pain
• Bleeding
• Bruising
• Infection
• Scarring
• Blood clots (deep vein thrombosis)
  

Specific complications of LICAP flap reconstruction may include:

• Further surgery needed
• Seroma – fluid buildup in your wound
• Wound breakdown
• Loss of sensation or numbness
• Flap failure/loss
• Inability to proceed with the reconstruction

• Shoulder stiffness