AICAP Flap After Lumpectomy: What It Is, Who It Is For, Scars and Recovery
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What are my options if the shape of my breast changes after a lumpectomy? One option is an AICAP flap. The surgeon moves a piece of skin and fat from just below the breast into the gap left by the lumpectomy. The tissue keeps its own blood supply, so the breast keeps its shape without an implant. This article explains what an AICAP flap is, who it suits, where the scars are and how recovery goes.
Comparing partial breast reconstruction options? Read the LICAP flap guide and bring your questions to your surgical team.
In this article
What is an AICAP flap?
AICAP stands for anterior intercostal artery perforator. These are small blood vessels that come out between the ribs at the front of the chest. An AICAP flap is a piece of skin and fat from just below the breast crease. It stays attached to one of these small vessels. The surgeon turns it into the breast to fill the gap after the lumpectomy.
Doctors call this partial breast reconstruction, or oncoplastic surgery. Oncoplastic means: removing the cancer and reshaping the breast in one operation. The AICAP flap is a local flap. The tissue comes from right next to the breast. No vessels need to be joined under a microscope, and no muscle is removed.
The AICAP flap belongs to a small family of local flaps. The LICAP flap uses tissue from the side of the chest, for the outer breast. The AICAP flap uses tissue from the front of the chest, below the breast, for the lower and inner breast. This is the area near the breastbone, where a dent is often easy to see in a low neckline.
Open the existing AICAP animation in the video library. It shows the general technique; your own operation may differ.
Who is an AICAP flap for?
An AICAP flap can be a good choice if:
Your tumour is in the lower or inner part of the breast.
You want to keep your breast (breast-conserving surgery) rather than have a mastectomy.
Your breast is small or medium, so moving breast tissue around would not fill the gap.
You want to keep your breast size and do not want the other breast made smaller.
You prefer your own tissue to an implant.
There is enough skin and fat just below the breast crease.
The AICAP flap is usually done in the same operation as the lumpectomy. It can also be done later, to correct a dent after an earlier lumpectomy, with or without radiotherapy. Your plastic surgeon looks at where the tumour is, the size of your breast and the tissue below it. Together you decide whether this technique fits you.
How is AICAP breast surgery done?
Illustration: the AICAP flap restores the shape of the lower and inner breast with skin and fat taken from just below the breast crease; the scar lies in or near that crease.
The operation has a few clear steps. It is done under general anaesthesia.
Before the operation, the surgeon finds the best blood vessel with a small ultrasound (Doppler) or a CT scan. The flap is drawn around this vessel.
The breast surgeon removes the tumour with a rim of healthy tissue (a clear margin).
The plastic surgeon frees the flap of skin and fat from just below the breast crease. The small vessel stays attached.
The flap is turned into the gap in the lower or inner breast. If no extra skin is needed, the top layer of skin is removed and the flap sits fully under the breast skin.
The breast and the donor area are closed. The surgeon shapes the breast so both sides look balanced.
Because the flap keeps its own blood supply, the tissue stays healthy. It feels much like breast tissue, so the result looks and feels natural.
AICAP vs LICAP flap
The AICAP flap and the LICAP flap are close relatives. The difference is where the tissue comes from and which part of the breast it fills. The LICAP flap (lateral intercostal artery perforator) uses tissue from the side of the chest, under the arm. It fills gaps in the upper and outer breast. The AICAP flap uses tissue from below the breast. It fills gaps in the lower and inner breast. Both keep the muscle intact and need no microsurgery. Read more in our article on the LICAP flap after lumpectomy.
Scars after an AICAP flap
You will have two scars, and they are often close together. The lumpectomy scar sits on the breast, where the tumour was removed. The donor scar runs along or just below the crease under the breast. A bra or bikini usually covers it. In some women the two scars join into one longer scar in the crease.
Scars are red and firm at first. Over one to two years they become paler and softer. Sun protection helps. Your team may also advise scar massage or silicone tape. The lower breast may look a little full at first. This usually settles as the swelling goes down.
Recovery after an AICAP flap
Recovery after an AICAP flap is much like recovery after other local flaps. Below is what most women notice, phase by phase.
The first days
Most women stay in hospital for one to two nights. You may have a small drain for a short while. The breast and the area below the crease feel swollen, bruised and sore. Standard painkillers usually keep this under control. Your team checks the flap regularly to see that the blood supply is good.
Weeks 1 to 2
You feel tired, and the breast feels tight. Light daily activities are fine. Avoid heavy lifting and stretching the arm high. Wear a soft, supportive bra day and night if your team advises this. Contact your team if redness spreads, if you have a fever, if the wound opens, or if the flap area turns dark or cold.
Weeks 2 to 6
Most women return to work within two to four weeks, depending on how physical the job is. The swelling goes down and the shape of the breast becomes clearer. If you need radiotherapy, it usually starts in this period, once the wounds have healed.
After 6 weeks
Sport and heavy lifting are usually possible again after six to eight weeks. The final shape takes several months, and longer if you have radiotherapy. A small dent can later be corrected with lipofilling if needed.
AICAP flap and radiotherapy: timing
Many women who have a lumpectomy also need radiotherapy. The AICAP flap is normally done before radiotherapy, in the same operation as the lumpectomy. Radiotherapy can usually start on schedule once the wounds have healed, often about four to six weeks after surgery. The flap brings in healthy tissue with a good blood supply, which tends to cope well with radiotherapy. Your surgeon and your radiation oncologist plan this together, so your cancer treatment is not delayed.
If you already had radiotherapy and a dent developed later, an AICAP flap is still possible in many cases. Healing is slower in radiated skin, so your surgeon will check the tissue carefully first.
Alternatives to an AICAP flap
An AICAP flap is one of several ways to keep a good breast shape after a lumpectomy:
Rearranging breast tissue: for small gaps in a larger breast, the surgeon moves nearby breast tissue into the gap.
Oncoplastic reduction: for larger breasts, the surgeon removes the tumour as part of a breast reduction. The other breast is often reduced too, for balance. Read more about shape-preserving and oncoplastic techniques.
Lipofilling (fat grafting): the surgeon injects your own fat, taken from the belly or thighs, into a small dent. This often needs two or three sessions and is usually done after radiotherapy. Read more about lipofilling for small breast defects.
LICAP flap: for gaps in the upper and outer breast.
Mastectomy with reconstruction: if the tumour is large compared with the breast.
None of these is best for everyone. The right choice depends on where the tumour is, the size of your breast, your radiotherapy plan and your own wishes.
Frequently asked questions about the AICAP flap
What is AICAP?
AICAP is short for anterior intercostal artery perforator. It is the name of the small blood vessel that feeds the flap. This vessel comes out between the ribs at the front of the chest, just below the breast. Surgeons use the same name for the flap and for the operation.
What is an AICAP flap used for?
An AICAP flap is used to fill a gap in the lower or inner breast after a lumpectomy. It restores the shape of the breast without an implant. It can be done in the same operation as the lumpectomy, or later to correct a dent.
How long is recovery after an AICAP flap?
Most women stay in hospital for one to two nights. Light daily activities are possible within one to two weeks. Most women return to work within two to four weeks, depending on their job. Sport and heavy lifting usually wait until six to eight weeks.
AICAP vs LICAP: what is the difference?
Both are local flaps of skin and fat that keep their own blood supply. The LICAP flap comes from the side of the chest and fills the upper and outer breast. The AICAP flap comes from below the breast and fills the lower and inner breast. Neither removes muscle or needs microsurgery.
Where is the scar after AICAP breast surgery?
The donor scar lies in or just below the crease under the breast. A bra usually covers it. There is also a lumpectomy scar on the breast itself. Both scars fade over one to two years.
Can I have an AICAP flap if I need radiotherapy?
Yes. The AICAP flap is usually done before radiotherapy, together with the lumpectomy. Radiotherapy can normally start once the wounds have healed, often four to six weeks after surgery. The flap tissue has a good blood supply and tends to cope well with radiotherapy.
Is an AICAP flap a breast reconstruction?
Yes, it is a form of partial breast reconstruction. Your own breast stays in place. Only the part that was removed is replaced with tissue from just below the breast. This is different from a full reconstruction after a mastectomy, such as a DIEP flap or an implant.
Questions to ask your surgeon
Why does an AICAP flap suit my tumour and my breast?
What are the alternatives in my case, and what are their pros and cons?
Where exactly will my scars be, and can they be joined into one?
How does this operation fit into my radiotherapy plan?
What happens if the tissue does not heal well, or if the margins are not clear?
Book and further information
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Written by Dr. Mahyar Foumani, plastic and reconstructive surgeon specializing in breast reconstruction. Based on the book 'Breast Reconstruction Explained.'
This article is education, not medical advice
This article explains in plain words how breast reconstruction works. It is meant to help you understand what is possible, so that you and your doctor can make a good decision together. It does not replace personal medical advice.
Every situation is different. What is best for you depends on your body, your illness, your treatment and your own wishes. So always follow the advice of your own doctor or care team. Do you have symptoms, or are you unsure about something? Please contact your doctor or GP. In an emergency, call your local emergency number.
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