Chest wall perforator flap breast reconstruction

A chest wall perforator flap (CWPF) breast reconstruction is an operation to recreate a breast shape or restore volume to the breast after you have had surgery for breast cancer.

The aim is to replace the breast tissue removed at the time of cancer surgery with skin and fat from the chest wall (under your arm or breast). This will help restore the size and shape of your breast. This procedure is normally carried out after a wide local excision (lumpectomy) for breast cancer.

The main benefit of surgery is that the cancer is removed from the breast. As long as there is enough healthy tissue around the tumour, patients who have this surgery do not usually need to have their breast removed.

You should get a natural breast shape again and the volume should be similar to the other breast.

There is a lower risk of complications with lumpectomy and CWPF reconstruction compared to mastectomy with total breast reconstruction.

Using padded bras or bra inserts can give the appearance of a breast shape when you are wearing clothes.

It may be possible to use tissue from another area of your body. You may be suitable for breast reconstruction using tissue expanders or implants.

A breast reconstruction will not improve your physical health. Your surgeon may be able to recommend an alternative to recreate a breast shape. Your healthcare team may be able to provide prosthetic and underwear fitting which may help with your body image.

If you are booked in for immediate reconstruction as part of your cancer surgery, you should not have to wait too long. Your healthcare team will talk to you about this.

On the morning of your surgery, your surgeon will draw on you to show where the cuts will be made and explain where you will have scars after the operation

The operation is performed under a general anaesthetic and usually takes 1 to 2 hours.

Once your cancer has been removed your surgeon will move a flap of skin and fat from the chest and use it to recreate a breast shape in the space left in your breast by the cancer.

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. If you gain weight after your cancer surgery, this operation may not be considered safe.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the breast cancer team or your GP for advice.

You can reduce your risk of infection in a surgical wound by taking the following steps:

• In the week before the operation, do not shave or wax the area where a cut is likely to be made.
• Try to have a bath or shower either the day before or on the day of the operation.
• Keep warm around the time of the operation. Let the healthcare team know if you feel cold.

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• Bleeding during or after the operation.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Blood clot in your leg (deep-vein thrombosis – DVT).
• Blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs.
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.

Specific complications of this operation

• Developing a lump under your wound caused by fluid collecting.
• Developing a lump under your wound caused by blood collecting.
• Wound breakdown, where a wound fails to heal and opens up.
• Skin necrosis, where some of the skin at the edge of your wound on your back or chest dies leaving a black area. You may need special dressings or, rarely, a skin graft using skin from another area of your body.
• Difference in shape and appearance.
• Numbness or altered sensation or continued pain around your armpit, across your chest or the inner part of your arm caused by injury to the small nerves that supply your skin. Numbness can last for up to 6 months and can sometimes be permanent.
• It is important that all of the cancer is removed. You may need further surgery if your surgeon finds that the operation has not removed all of the cancer. Occasionally this may lead to a mastectomy where the whole breast is removed.
• There is a small risk (1 to 2 in 100) of the flap not working due to damage to its blood supply. If this happens you will need further surgery.
• You are likely to experience some tightness after the surgery due to the scar tissue. This may affect your shoulder movements but this should improve within several weeks.
• During the operation there is a possibility that your surgeon will be unable to go ahead with the reconstruction. In this case the removal of your cancer will still go ahead and you may be offered alternative forms of breast reconstruction later.

Fewer than 1 in 5 people will need to come back to hospital or have another operation in the first 3 months after surgery.

Consequences of this procedure

• Pain.
• Scarring of your skin.
• Unless your surgeon has discussed it with you before the operation, there will not usually be any scarring on the breast itself. However, in some cases your surgeon might need to remove the skin on the breast if the cancer is close to the skin.

You should be able to go home the same day or the following day.

You should be able to return to normal activities after 4 to 6 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Do not do rigorous sports, such as tennis, horse-riding, golf or aerobics, for 2 months without asking your surgical team for advice. Before you start exercising, ask the healthcare team or your GP for advice.

The healthcare team will arrange an appointment for you within 3 weeks. Your surgeon will check your wounds and tell you when you can return to work. The breast tissue (and any lymph nodes if removed) will have been examined under a microscope. Your healthcare team will tell you the results and discuss with you any treatment or follow-up you need.

Breast cancer may come back despite the best available treatment.

A CWPF breast reconstruction is an operation to remove cancer and recreate a breast shape at the same time.