Background: Oncoplastic breast surgery seeks to preserve aesthetic outcomes without compromising oncological safety. Various flap techniques based on tumour location exist, yet limited evidence exists evaluating perforator-based oncoplastic breast reconstruction. This study evaluates surgical and patient-reported outcomes of partial breast reconstruction using chest wall perforator flaps (CWPFs) without Doppler assistance.
Methods: The study included 137 patients who underwent CWPFs post-January 2020 and completed 1 year of follow-up before April 2025. Data were analysed from a prospectively maintained database, recording demographics, perioperative events and surgical outcomes. Patient satisfaction was assessed with the BREAST-QTM questionnaire six months after radiotherapy completion.
Results: The mean age of the study population was 48.1 years. Lateral intercostal artery perforator, medial intercostal artery perforator and anterior intercostal artery perforator were performed in 59.1%, 28.5%, and 12.4%, respectively. Mean operative time for flap harvesting and insetting was 41, 23 and 25 minutes, respectively. Postoperative complications, graded using the Clavien–Dindo classification, included minor wound dehiscence (9.49%), marginal flap necrosis (2.91%), seroma (2.18%) and hematoma (0.72%). Adjuvant radiation therapy was completed by 97.08% of patients. The BREAST-QTM questionnaire, answered by 113 patients (82.4%), revealed the highest satisfaction scores for breast surgeon, medical team and office staff (median interquartile range (IQR) of 100 (0)), while sexual well-being scored lowest (median (IQR) of 72 (46)).
Conclusion: No-Doppler CWPFs offer a simple, reliable and safe solution for partial breast reconstruction, delivering high patient satisfaction without reliance on specialised imaging. This muscle-sparing, cost-effective approach reinforces the importance of anatomical precision over technology, making it a valuable addition to oncoplastic practice in diverse healthcare environments.
