Expanding the Borders of Perforator Flap Application in Breast Surgery: Novel Techniques in Breast-Conserving, Aesthetic, and Salvage Procedures

Breast surgery increasingly employs various autologous tissue-based techniques. While free flaps (i.e. DIEP) remain the gold standard in post-mastectomy breast reconstruction, local perforator flaps have potential to fill various defects or even improve breast cosmesis without microvascular anastomosis. They are especially useful in breast conserving surgery (BCS), enabling surgeons to avoid mastectomy in patients. The indications for these techniques are not limited to BCS; chest wall perforator flaps can be applied to breast augmentation or mastopexy-augmentation in some patient groups, such as post–massive weight loss patients. Necrotic complications in post-mastectomy implant-based reconstruction, that historically were indications to implant removal are now successfully managed with local perforator flaps. Taking into account the versality of chest wall perforator flaps, it is crucial to explore the possible outcomes with this technique.With the growing popularity of local flaps in breast surgery it is crucial to fully elucidate their usefulness in terms of indications, expected results and possible complications. In BCS, local perforators flaps can spare mastectomies in a significant portion of patients. Nevertheless, we still lack a larger body of evidence on oncological and patient-related outcomes (PROM). While most studies show that chest wall perforator flaps are associated with low complications rate and good aesthetic results, there is a paucity of studies on long-term outcomes, especially PROMs. Similarly, in other breast procedures with local perforator flaps there is a need for broader evaluation of outcomes. As for surgical technique and flap planning there are already well-established principles, however the robustness of their vascularity spurs surgeons to expand the application of these flaps and modify their harvesting.Therefore, the aim of this research topic is to systemize the current knowledge on local perforator flaps in breast surgery and how their advent has changed clinical practice, especially in patient qualification to BCS. In the era of “tailored breast surgery” it is also paramount to emphasize studies on PROMs as long-term patients’ satisfaction is equally important in both oncological and aesthetic breast surgery.We welcome articles addressing, but not limited to, the following themes:• Chest-wall perforator flaps in breast conserving surgery: evaluation of oncological and patients-related outcomes• Comparison of outcomes between chest-wall perforator flaps and other surgical techniques in breast cancer• Surgical techniques in local perforator flaps- techniques in preoperative assessment of perforators, flap planning and harvesting techniques• Anatomical studies on localization of perforators and main pedicles: implications for surgical technique• Novel concepts in local perforator flaps• Local perforator flaps in implant salvage• Local perforator flaps in aesthetic breast surgery: patients' selection and patient-related outcomes Topic editors: Aleksander Skulimowski, Rafal Matkowski Source: https://www.frontiersin.org/research-topics/78873/expanding-the-borders-of-perforator-flap-application-in-breast-surgery-novel-techniques-in-breast-conserving-aesthetic-and-salvage-procedures