AICAP Flap: Inner Breast Reconstruction After Lumpectomy
- Dr. Mahyar Foumani
- Mar 14
- 5 min read
Updated: 3 days ago
When breast cancer is in the inner (medial) part of the breast, a lumpectomy can leave a clear dent that is hard to repair. For tumours in the outer breast, techniques like the LICAP flap work very well. But inner-breast dents have long had fewer reliable options. The AICAP flap — short for Anterior Intercostal Artery Perforator flap — changes that. It is a technique made specifically to rebuild the inner breast after a lumpectomy.
What Is the AICAP Flap?
The AICAP flap is an oncoplastic technique (combining cancer removal with reshaping the breast in one operation) that replaces lost volume. It uses tissue from the front of the chest wall — the skin and fat just below the crease under the breast — to fill the gap left when a tumour is removed from the inner breast. The flap gets its blood supply from small vessels (perforators) that branch off the intercostal arteries, which run between the ribs along the front of the chest.
This technique is part of a family of local perforator flaps. The better-known LICAP (Lateral Intercostal Artery Perforator) flap handles outer-side dents, and the TDAP (Thoracodorsal Artery Perforator) flap handles upper-outer dents. While those sister techniques cover the side and back of the breast, the AICAP flap is aimed at the inner breast — the area closest to the breastbone — where the other flaps have limited reach.
How Does the Procedure Work?
The AICAP flap is done together with the lumpectomy, usually as a single oncoplastic operation. Here is how it goes:
First, the cancer surgeon removes the tumour from the inner breast, with a clear margin. This leaves a gap in the inner breast that, if not filled, would cause a visible dent or unevenness.
Next, the plastic surgeon designs the AICAP flap on the front of the chest wall, usually just below and toward the middle of the breast crease. Using a scan beforehand (CT angiography or a small handheld ultrasound called a Doppler), the surgeon finds the strongest feeding vessels from the anterior intercostal arteries. The flap — skin and the fat under it — is then carefully freed, while these key vessels are kept intact.
The prepared flap is rotated into the lumpectomy gap, filling it with healthy tissue that closely matches the texture of breast tissue. Because the flap stays joined to its blood supply through the perforator vessels, there is no need to reconnect any vessels under a microscope. This makes it a reliable procedure with consistent results.
Finally, both the donor site and the breast are closed, and the surgeon shapes the breast for the best balance. The scar at the donor site is usually hidden in or near the crease under the breast.
Benefits of the AICAP Flap
The AICAP flap has several important advantages for women with inner-breast tumours. The tissue from the front of the chest is an excellent match for natural breast tissue in texture and thickness, so the result looks and feels natural. Because it is a perforator-based technique, no important muscle is removed. That means little effect on chest-wall function and a faster recovery.
The procedure brings healthy, non-radiated tissue into the breast, which is especially valuable for women who will have radiation after surgery. The flap restores a good amount of volume, so a large dent can be corrected without reducing the other breast. And because the donor scar is hidden near the breast crease, the cosmetic result is often excellent.
Recovery and What to Expect
Recovery after an AICAP flap is much like other local perforator flap techniques. Most patients stay in hospital for one to two nights. In the first two weeks, expect some swelling, bruising, and soreness at both the breast and the donor site. Pain is usually well managed with standard medication.
Most women return to light daily activities within one to two weeks, and to work within two to four weeks, depending on how physical their job is. Full recovery, including exercise and demanding activity, usually takes about six to eight weeks. Your surgeon will keep a close eye on the flap during the early recovery.
If radiation is part of your plan, it can usually go ahead on schedule once you have healed, often about four to six weeks after surgery. The healthy, well-supplied tissue brought in by the AICAP flap tends to handle radiation better than tissue that has simply been rearranged.
Who Is a Good Candidate?
The AICAP flap suits women with tumours in the inner part of the breast who are having breast-conserving surgery (a lumpectomy). Ideal candidates include women with small to medium breasts, where simply rearranging tissue would not replace enough volume; women who want to keep their natural breast size, rather than reducing the other breast; and patients whose tumour sits in the inner breast, where options like the LICAP or TDAP are less suitable.
The procedure also works well for secondary reconstruction — correcting a dent that formed after an earlier lumpectomy, with or without radiation. Your plastic surgeon will look at your anatomy, the tumour’s place, and the tissue you have to decide whether the AICAP flap is the best choice for you.
Frequently Asked Questions
What does AICAP stand for?
AICAP stands for Anterior Intercostal Artery Perforator. It refers to the blood vessels that feed the flap — small branches from the intercostal arteries, which run between the ribs along the front of the chest wall.
How is the AICAP flap different from the LICAP flap?
The main difference is location. The LICAP flap uses tissue from the side of the chest wall, and is ideal for outer-breast dents. The AICAP flap uses tissue from the front of the chest wall, below the breast, and is made for inner-breast dents. Both are perforator flaps that keep the muscle working.
Will I need microsurgery for an AICAP flap?
No. The AICAP flap stays joined to its blood supply through the perforator vessels. It is rotated into the gap without being fully detached, so there is no need to reconnect vessels under a microscope. This makes it shorter and simpler than free-flap techniques like the DIEP flap.
Can I have radiation after an AICAP flap?
Yes. Radiation can usually go ahead as planned once you have healed, often four to six weeks after surgery. The healthy, well-supplied tissue from the AICAP flap generally handles radiation well — one of the advantages of bringing fresh tissue into the area.
What kind of scar will I have from the AICAP flap?
The donor scar usually sits near or within the crease under the breast. So it is generally well hidden by clothing and underwear. Over time, the scar fades a lot and becomes barely noticeable for most patients.
Written by Dr. Mahyar Foumani, plastic and reconstructive surgeon specializing in breast reconstruction. Based on the book 'Breast Reconstruction Explained.'
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