Lateral Intercostal Artery Perforator Flap for Axillary Breast Reconstruction in a Previously Irradiated and Dissected Field

Abstract Reconstruction of axillary defects after oncologic resection is particularly challenging in patients with prior axillary dissection and radiation, as traditional thoracodorsal-based flaps may be unreliable. We present a case of a 59-year-old woman with recurrent left axillary invasive ductal carcinoma, 18 years after lumpectomy, axillary dissection, chemotherapy, and radiation. En bloc resection involving the pectoralis minor and serratus anterior created a 6 × 5 × 2 cm defect with exposed rib. A lateral intercostal artery perforator (LICAP) flap was used for reconstruction, based on a dominant perforator at the sixth intercostal space identified by Doppler and confirmed intraoperatively with indocyanine green angiography. The flap was de-epithelialized, tunneled to the axilla, and the donor site closed primarily. The patient achieved complete healing without necrosis or contracture and maintained full shoulder mobility after adjuvant chemoradiation. The LICAP flap offers a safe, reliable option for axillary reconstruction in previously treated fields.