Research Article|Articles in Press

The Reverse LICAP Flap: A Laterally Based Submammary Perforator Flap for Breast Reconstruction



      Traditional donor sites for autologous breast reconstruction include the abdomen, thigh, buttock, and posterior thorax. The authors describe the use of the reverse lateral intercostal perforator (LICAP) flap originating from the submammary region as an alternative option for breast reconstruction.


      Fifteen patients (30 breasts) were included in this retrospective review. The procedure was performed for immediate reconstruction following a nipple sparing mastectomy utilizing an inframammary incision or an inverted T pattern with preservation of the 5th anterior intercostal perforator (n=8), volume replacement after implant explantation (n=5) and partial lower pole resurfacing with exteriorization of a portion of the LICAP skin paddle (n=2).


      Flap survival was achieved in all patients. Three flaps (10%), had 1-2 cm of intraoperative distal tip ischemia managed by excision prior to inset and closure. At 12-month post-operative follow-up, a stable result with good nipple position, breast shape, and projection was demonstrated in all patients.


      The reverse LICAP flap is a safe, effective and reliable option for breast reconstruction following mastectomy.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hamdi M.
        • Van Landuyt K.
        • de Frene B.
        • Roche N.
        • Blondeel P.
        • Monstrey S.
        The versatility of the inter-costal artery perforator (ICAP) flaps.
        J Plast Reconstr Aesthet Surg. 2006; 59: 644-652
        • McCulley S.J.
        • Schaverien M.J.
        • Tan V.K.M.
        • Macmillan D.R.
        Lateral thoracic artery perforator (LTAP) flap in partial breast reconstruction.
        J Plast Reconstr Aesthet Surg. 2015; 68: 686-691
        • Hamdi M.
        • Spano A.
        • Van Landuyt K.
        • D’Herde K.
        • Blondeel P.
        • Monstrey S.
        The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery.
        Plast Reconstr Surg. 2008; 121: 389-396
        • Hamdi M.
        • Van Landuyt K.
        • Blondeel P.
        • Hijawi J.B.
        • Roche N.
        • Monstrey S.
        Autologous breast augmentation with the lateral intercostal artery perforator flap in massive weight loss pa- tients.
        J Plast Reconstr Aesthet Surg. 2009; 62: 65-70
        • Meybodi F.
        • Cocco A.L.
        • Messer D.
        • Brown A.
        • Kanesalingam K.
        • Elder E.
        • Hsu j
        • French j
        The modified lateral intercostal artery perforator flap PRS GO. 2019;
        • Wong C.
        • Maia M.
        • Saint-Cyr M.
        Lateral Intercostal Artery Perforator Flap in Combination with Thoracoabdominal Advancement Flap for Correction of Contour Deformities following Autologous Breast Reconstruction Plast Reconstr Surg.
        . 2011; 127: 156e
        • Stillaert F.B.
        • Casaer B.
        • Roche N.
        • Van Landuyt K.
        • Hamdi M.
        • Blondeel P.N.
        • Monstrey S.
        The inframammary extending lateral intercostal artery perforator flap for reconstruction of axillary contractures: a case report Journal of Plastic.
        Reconstructive & Aesthetic Surgery. 2008; 61: e7ee11
        • Angrigiani C.
        • Grilli D.
        • Siebert J.
        Latissimus dorsi musculocutaneous flap without muscle.
        Plast. Reconstr. Surg. 1995; 96: 1608-1614
        • Angrigiani C.
        • Grilli D.
        • Thorne C.
        The Adductor flap A new method for transferring posterior and medial thigh flap.
        Plast. Reconstr Surg 107. 1725; 2001
        • Angrigiani C.
        • Rancati A.
        • Varela I.
        • Rancati A.
        • Nahabedian M.Y.
        • Neligan P.
        The Deltopectoral/Internal Mammary Artery Perforator Flap Revisited. Annals of Plast. Surg.
        . 2022; 88: 88
        • Yu P.
        • Roblin P.
        • Chevray P.
        Internal mammary artery perforator (IMAP) flap for tracheostoma reconstruction.
        Head Neck. 2006; 28: 723-729
        • Vessely M.-J.
        • Murray D.-J.
        • Novak C.-B.
        • et al.
        The internal mammary artery perforator flap: an anatomical study and a case report.
        Ann Plast Surg. 2007; 58: 156-161
        • Nahabedian M.Y.
        • Angrigiani C.
        • Rancati A.
        • Irigo M.
        • Acquaviva J.
        • Rancati A.
        The Importance of Fifth Anterior Intercostal Vessels following Nipple-Sparing Mastectomy.
        Plast Reconstr. Surg. 2022; 149 (Mar 1): 559-566
        • Rebello C.
        • Franco T.
        Abdominoplasty through a submammary incision.
        Int Surg. 1977; 62: 462-463
        • Agha-Mohammadi S.
        • Hurwitz D.J.
        Management of upper abdominal laxity after massive weight loss: Reverse abdominoplasty and inframammary fold reconstruction.
        Aesthetic Plast Surg. 2010; 34: 226-231
        • Avelar J.M.
        Upper abdominoplasty without panniculus underminning and resection.
        in: Avelar J.M. Abdominoplasty: Without Panniculus Undermining and Resection. São Paulo: Hipocrates. 2002
        • Deos M.F.
        • Arnt R.A.
        • Gus E.I.
        Tensioned Reverse Abdominoplasty PRS. 2009; 124
        • Bury T.F.
        • Reece G.P.
        • Janjan N.A.
        • et al.
        Closure of massive chest wall defects after full-thickness chest wall resection.
        Ann Plast Surg. 1995; 34: 409-414
        • De la Plaza R.
        • Arroyo J.M.
        • Vasconez L.O.
        Upper transverse rectus abdominis flap: the flag flap.
        Ann Plast Surg. 1984; 12: 410-418
        • Kalender V.
        • Aydin H.
        • Karabulut A.B.
        • et al.
        Breast reconstruction with the internal mammary artery pedicled fasciocutaneous island flap: description of a new flap.
        Plast Reconstr Surg. 2000; 106: 1494-1498
        • Zenn M.R.
        • Heitmann C.
        Extended TRAM flap: feasibility study of fresh human cadavers.
        Ann Plast Surg. 2003; 50: 256-262
        • Persichetti P.
        • Simone P.
        • Scuderi N.
        Anchor-line abdominoplasty: A comprehensive approach to abdominal wall reconstruction and body contouring.
        Plast Reconstr Surg. 2005; 116: 289-294
        • Carrasco-Lopez C.
        • Julian Ibañez J.F.
        • Vila J.
        • Rodriguez Baeza A.
        • et al.
        The anterior intercostal artery flap:anatomical and radiological study.
        Plast Reconstr Surg. 2017; 139: 613e
        • Ombredanne L.
        Restauration autoplastique du sein aprés amputation totale Trb.
        Med. 1906; 4: 325
        • Juri J.
        • Letiz S.
        • Valotta F.
        Submammary flap for Correction of Severe Sequelae from Augmentation Mammaplasty.
        Plast Recnstr Surg. 2004; 114: 567
        • Caldeira A.M.L.
        • Barral S.M.
        • Araujo I.D.
        • Thomaz D.R.
        Aesthetic Abdominal and Breast Reconstruction with Reverse Lateral Thoracodorsal Flap.
        PRS. 2008; 121: 347e
        • Vessely M.J.
        • Murray D.J.
        • Novak C.B.
        • Gullane P.J.
        • Neligan P.C.
        The internal mammary artery perforator flap: an anatomical study and a case report.
        Ann Plast Surg. 2007; 58: 156-161
        • Angrigiani C.
        • Grilli D.
        • Siebert J.
        Latissimus dorsi musculocutaneous flap without muscle.
        Plast Reconstr Surg. 1995; 96: 1608
        • Koshima I.
        • Soeda S.
        Inferior epigastric artery skin flaps without rectus abdominis muscle.
        Br J Plast Surg. 1989; 42: 645