E2160. Imaging Appearance of Breast Reconstruction Using the Intercostal Artery Perforator Flap: A Primer for Breast Radiologists
  1. Miriam Becker; UC San Diego Health
  2. Kelli Lopes; UC San Diego Health
  3. Robert Clark; UC San Diego Health
  4. Garrison Leach; UC San Diego Health
  5. Christopher Reid; UC San Diego Health
  6. Haydee Ojeda-Fournier; UC San Diego Health
Breast oncoplastic surgery aims to maintain the aesthetic and psychological well-being of patients undergoing surgical management of their breast cancer. Breast-conserving therapy (BCT) using the intercostal artery perforator (ICAP) flap is an emerging plastic surgery technique that allows previously ineligible patients to forgo mastectomy when the lumpectomy size would cause severe disfigurement. This flap has the potential to decrease donor site morbidity and appears to offer excellent cosmetic results. Due to the newness of the technique, little is known about its imaging appearance and long-term effects in subsequent postoperative breast imaging. Fat necrosis is a known sequela of the surgical breast and can, in the early stages, cause false positive findings, leading to patient anxiety and possible unnecessary biopsy. Whether the same is true for ICAP-flap BCT is currently unknown. This exhibit reviews a single academic center's early imaging experience following ICAP flap BCT. The clinical advantages and potential complications of ICAP BCT are also reviewed.

Educational Goals / Teaching Points
At the end of this educational exhibit, the learner will understand the ICAP reconstruction for breast-conserving therapy, recognize the appearance of the ICAP flap in breast imaging, and identify a “normal” ICAP flap and ICAP flap expected postsurgical and postradiation changes.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
XR mammography, digital breast tomosynthesis, CT scans, and breast MRIs were assessed. Image findings include fat necrosis, calcifications, skin and nipple retraction, and skin thickening. It is essential to recognize the ICAP flap and the expected sequelae of the flap reconstruction in multiple modalities so as not to misinterpret benign or malignant findings.

Breast-conserving therapy using an ICAP flap is a novel procedure that radiologists should become familiar with, recognizing the expected imaging appearance and short and long-term changes, including the potential development of fat necrosis.