LICAP Flap: Breast Reconstruction After Upper/Lateral Lumpectomy

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When a breast tumor is located in the upper or lateral (outer) portion of the breast, a lumpectomy can leave a significant defect that changes the shape and contour of the breast. For women with smaller breasts or larger tumors in these areas, standard tissue rearrangement techniques may not provide enough volume to restore a natural appearance. This is where the LICAP flap — the Lateral Intercostal Artery Perforator flap — offers an elegant oncoplastic solution.

What Is a LICAP Flap?

The LICAP flap is a volume replacement technique used in oncoplastic breast surgery. It uses tissue — skin and fat — from the lateral chest wall (your side), which is rotated forward into the breast to fill the cavity created after tumor removal. The tissue remains connected to its blood supply through small perforating vessels that branch from the lateral intercostal arteries, ensuring reliable healing and excellent tissue survival.

Unlike larger flap procedures such as the DIEP flap or latissimus dorsi flap used for total breast reconstruction, the LICAP flap is a local perforator flap designed specifically for partial breast reconstruction. It does not require microsurgery, and it preserves the underlying muscles entirely. The result is a less invasive procedure with a faster recovery compared to traditional flap surgeries.

Why Is the LICAP Flap Ideal for Upper and Lateral Breast Tumors?

The LICAP flap is particularly well-suited for tumors in the upper outer quadrant and lateral regions of the breast. This is because the donor tissue — taken from the lateral chest wall — is immediately adjacent to these areas. The tissue has a similar texture and quality to breast tissue, providing an excellent match that feels and looks natural after healing.

Surgeons identify the perforating blood vessels before surgery using CT angiography or Doppler ultrasound mapping. This preoperative imaging allows precise flap design centered on the strongest perforating vessels, maximizing blood supply and ensuring the transferred tissue thrives in its new location.

How the Procedure Works

The LICAP flap procedure is typically performed simultaneously with the lumpectomy — an oncoplastic approach that combines cancer removal and reconstruction in a single operation. Here is an overview of the steps involved:

First, the oncological surgeon removes the tumor with adequate margins. This creates a cavity in the upper or lateral breast. Next, the plastic surgeon harvests a flap of skin and fat from the lateral chest wall, carefully preserving its blood supply through the lateral intercostal artery perforator vessels. The flap is then rotated into the lumpectomy cavity to restore volume and shape. If additional skin is not needed, the flap may be de-epithelialized (the outer skin layer removed) before insertion. Finally, the donor site on the lateral chest wall is closed directly, leaving a scar that typically lies within the bra line or under the arm.

Benefits of the LICAP Flap

The LICAP flap offers several important advantages for women facing lumpectomy for upper or lateral breast tumors. It provides substantial volume restoration even for larger defects, allowing correction of asymmetry without needing to reduce the opposite breast. Because the tissue comes from a nearby area rather than a distant site, the procedure is less invasive than traditional flap surgeries. No important muscles are sacrificed, which means minimal functional impact at the donor site. The tissue quality closely matches breast tissue, resulting in a natural look and feel. The donor site scar is well-hidden in the lateral chest wall area, typically beneath the bra line. Additionally, bringing healthy, non-irradiated tissue into the breast area can improve the quality of the reconstruction, especially when combined with subsequent radiation therapy.

Recovery and What to Expect

Recovery from LICAP flap surgery is generally faster than from larger flap procedures. Most patients stay overnight in the hospital and can return to work within approximately three weeks. During the initial recovery period, you will have some restrictions on arm movement and lifting on the operated side. Surgical drains may be placed temporarily to prevent fluid accumulation. Pain is usually manageable with standard medication, and most women report that discomfort subsides significantly within the first one to two weeks.

After full healing, the reconstructed breast typically looks remarkably natural. The scars fade significantly over time, and most patients are very satisfied with both the cosmetic outcome and the fact that their breast was preserved.

Who Is a Good Candidate?

The LICAP flap is an excellent option for women who have a tumor in the upper or outer quadrant of the breast and will undergo lumpectomy, whose breast size is too small to allow adequate reshaping with tissue rearrangement alone, who wish to maintain their natural breast size without reducing the opposite breast, who have sufficient tissue available on the lateral chest wall, and who want a single-stage reconstruction combined with cancer surgery. It is also valuable for women with secondary lumpectomy defects — contour irregularities that developed after a previous lumpectomy and radiation — where volume replacement can significantly improve breast 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 supply blood to the tissue used in this flap procedure.

Is the LICAP flap performed at the same time as the lumpectomy?

Yes, the LICAP flap is typically performed immediately following tumor removal during the same operation. This oncoplastic approach means you only undergo one surgery and one recovery period. In some cases, it can also be performed as a delayed procedure to correct deformities from a previous lumpectomy.

Will I lose muscle function from a LICAP flap?

No. One of the major advantages of the LICAP flap is that it does not sacrifice any muscle tissue. The flap consists of skin and fat only, with its blood supply coming through perforator vessels. This preserves full muscle function at the donor site.

Can the LICAP flap be combined with radiation therapy?

Yes. The LICAP flap can be performed before radiation therapy as part of the initial oncoplastic surgery. Bringing healthy, non-irradiated tissue into the breast can actually be beneficial, as it provides robust blood supply to the area that will receive radiation. Your radiation oncologist and surgeon will coordinate the treatment plan.

How visible will the scars be?

The donor site scar on the lateral chest wall is typically well-concealed beneath the bra line or in the natural fold under the arm. Over time, scars fade significantly. Most patients report that 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.'