# Immediate Breast Reconstruction with Fat-Graft-Augmented ICAP Flaps

## TL;DR

This study shows that combining ICAP flaps with fat grafting improves breast reconstruction outcomes after surgery, especially in terms of volume and appearance.

## Contribution

The novel approach of augmenting ICAP flaps with fat grafting is shown to be effective for immediate breast reconstruction.

## Key findings

- Fat-graft-augmented ICAP flaps provided satisfactory aesthetic outcomes and volume enhancement.
- Partial flap resorption occurred in 20% of cases, primarily in smokers.
- No skin necrosis was observed, indicating good flap viability.

## Abstract

Background: Intercostal artery perforator (ICAP) flaps are a reliable option for volume replacement in breast-conserving surgery (BCS), particularly for lower pole defects. However, limited flap volume may reduce their applicability in selected patients. Autologous fat grafting has been proposed to enhance both volume and aesthetic outcomes. Methods: This retrospective study evaluated 10 patients undergoing BCS with immediate reconstruction using fat-graft-augmented ICAP flaps. Nine anterior ICAP (AICAP) flaps and one lateral ICAP (LICAP) flap were employed. The outcomes included flap viability, complications, and aesthetic results over a 6-month follow-up. Results: Partial flap resorption occurred in 2 patients (20%), both of whom were active smokers. No cases of skin necrosis were observed. Fat grafting volumes ranged from 20 to 60 cc. Aesthetic outcomes were satisfactory, with good restoration of the breast contour and stable integration of the flap and grafted fat. Conclusions: The combined use of ICAP flaps and autologous fat grafting is a feasible and effective technique for immediate reconstruction after BCS. It allows volume enhancement, maintains natural contour, and shows low complication rates in properly selected patients. Smoking remains a significant risk factor.