LICAP Flap: Breast Reconstruction After Upper/Lateral Lumpectomy
- Dr. Mahyar Foumani
- Mar 9
- 5 min read
Updated: 3 days ago
When a breast tumour is in the upper or outer (side) part of the breast, a lumpectomy can leave a large gap that changes the breast’s shape. For women with smaller breasts, or larger tumours in these areas, simply rearranging the tissue may not give enough volume to restore a natural look. This is where the LICAP flap — the Lateral Intercostal Artery Perforator flap — offers an effective solution that combines removing the cancer with reshaping the breast in one operation (an oncoplastic approach).
What Is a LICAP Flap?
The LICAP flap is a technique used in oncoplastic breast surgery to replace lost volume. It takes tissue — skin and fat — from the side of your chest wall, and rotates it forward into the breast to fill the gap left after the tumour is removed. The tissue stays joined to its blood supply through small feeding vessels (perforators) that branch from the lateral intercostal arteries, between the ribs. This gives reliable healing and good tissue survival.
Larger flap procedures, such as the DIEP flap or the latissimus dorsi flap, are used to rebuild a whole breast. The LICAP flap is different: it is a local perforator flap, made specifically for partial reconstruction. It needs no microsurgery, and it keeps the muscles underneath fully intact. The result is a less invasive procedure with a faster recovery than traditional flap surgery.
Why Is the LICAP Flap Ideal for Upper and Outer Breast Tumours?
The LICAP flap suits tumours in the upper-outer and side parts of the breast especially well. That is because the donor tissue — taken from the side of the chest wall — is right next to these areas. The tissue has a texture and quality much like breast tissue, so it is an excellent match that looks and feels natural after healing.
Surgeons find the feeding blood vessels before surgery, using a CT scan (CT angiography) or a small handheld ultrasound called a Doppler. This lets them design the flap around the strongest vessels, giving it the best blood supply, so the moved tissue thrives in its new place.
How the Procedure Works
The LICAP flap is usually done at the same time as the lumpectomy — an oncoplastic approach that combines removing the cancer and rebuilding in one operation. Here is an overview of the steps:
First, the cancer surgeon removes the tumour with a clear margin. This leaves a gap in the upper or side part of the breast. Next, the plastic surgeon lifts a flap of skin and fat from the side of the chest wall, carefully keeping its blood supply through the lateral intercostal perforator vessels. The flap is then rotated into the gap to restore volume and shape. If no extra skin is needed, the outer skin layer may be removed first (a step called de-epithelialization) before the flap is tucked in. Finally, the donor site on the side of the chest is closed directly, leaving a scar that usually sits within the bra line or under the arm.
Benefits of the LICAP Flap
The LICAP flap has several important advantages for women facing a lumpectomy for an upper or side tumour. It restores a good amount of volume, even for larger gaps, so unevenness can be corrected without reducing the other breast. Because the tissue comes from nearby, rather than a distant site, the procedure is less invasive than traditional flap surgery. No important muscle is removed, so there is little effect on movement at the donor site. The tissue closely matches breast tissue, giving a natural look and feel. The donor scar is well hidden on the side of the chest, usually under the bra line. And bringing healthy, non-radiated tissue into the breast can improve the result, especially when radiation follows.
Recovery and What to Expect
Recovery from LICAP flap surgery is generally faster than from larger flap procedures. Most patients stay one night in hospital and can return to work within about three weeks. In the early recovery, you will have some limits on arm movement and lifting on the operated side. Surgical drains may be placed for a short while to stop fluid building up. Pain is usually easy to manage with standard medication, and most women find the discomfort eases a lot within the first one to two weeks.
After full healing, the reconstructed breast usually looks remarkably natural. The scars fade a lot over time, and most patients are very happy — both with the look and with the fact that their breast was saved.
Who Is a Good Candidate?
The LICAP flap is an excellent option for women who: have a tumour in the upper or outer part of the breast and will have a lumpectomy; have a breast too small to reshape well by rearranging tissue alone; want to keep their natural breast size, without reducing the other breast; have enough tissue on the side of the chest; and want a single operation that combines the reconstruction with the cancer surgery. It is also valuable for women with a dent left after an earlier lumpectomy and radiation, where replacing the lost volume can greatly improve the breast’s shape.
Frequently Asked Questions
What does LICAP stand for?
LICAP stands for Lateral Intercostal Artery Perforator. It refers to the small blood vessels (perforators) that branch from the intercostal arteries along the side of the chest wall, which feed the tissue used in this flap.
Is the LICAP flap done at the same time as the lumpectomy?
Yes. The LICAP flap is usually done right after the tumour is removed, in the same operation. This oncoplastic approach means just one surgery and one recovery. In some cases, it can also be done later, to correct a dent left by an earlier lumpectomy.
Will I lose muscle function from a LICAP flap?
No. One of the big advantages of the LICAP flap is that it sacrifices no muscle. The flap is skin and fat only, with its blood supply coming through the perforator vessels. This keeps full muscle function at the donor site.
Can the LICAP flap be combined with radiation?
Yes. The LICAP flap can be done before radiation, as part of the first oncoplastic surgery. Bringing healthy, non-radiated tissue into the breast can actually help, because it gives a strong blood supply to the area that will receive radiation. Your radiation doctor and surgeon will coordinate the plan.
How visible will the scars be?
The donor scar on the side of the chest is usually well hidden under the bra line, or in the natural fold under the arm. Over time, scars fade a lot. Most patients say the scars are barely noticeable once fully healed.
Written by Dr. Mahyar Foumani, plastic and reconstructive surgeon specializing in breast reconstruction. Based on the book 'Breast Reconstruction Explained.'
Comments