Lumpectomy With Perforator Flap

What is a Perforator Flap?

A perforator flap is a segment of a woman’s natural non-breast tissue (usually located underneath the breast, on the side of the breast, or the back) consisting of skin and fat that includes an isolated artery and vein that perforates the area, therefore, there is no need to transfer muscle tissue. Perforator flap reconstruction is a breast conservation technique that offers optimal cosmetic results in recreating breast mounds without the loss of muscle strength.

Who Is a Good Candidate?

For women who prefer to save their breasts and not undergo mastectomy, Dr. Schwartz can immediately reconstruct their breast defect with a perforator flap. Dr. Schwartz has been trained extensively in working with these flaps to reconstruct defects anywhere in the breast. Not only does this procedure allow Dr. Schwartz to save women’s breasts, but he can often further improve the appearance of these reconstructed breasts by performing a lift at the same time as the flap reconstruction. He was the first surgeon to describe combining a perforator flap and breast lift, publishing his approach in a renowned plastic surgery journal in 2018.

Consultation and Procedure

During your consultation, Dr. Schwartz will discuss with you the option of a lumpectomy with a perforator flap with a possible lift based on your breast size and shape, the extent of cancer that needs to be removed, and your desires. He will also explain and set the right expectations for your surgical outcome. Thanks to Dr. Schwartz’s access to a private Outpatient Surgery Center, his patients can expect to have their lumpectomy with perforator flap scheduled immediately. Lumpectomy with perforator flap, just like any other breast cancer diagnosis and treatment, is covered by health insurance companies.

Often, patients are sent to the breast center (located just one floor below our surgery center) for placement of a small wire into the breast to help localize the breast mass or cancer. Patients are then transported to our Outpatient Surgery Center where the wire, mass, and previously placed biopsy clip are removed.

Lumpectomy with perforator flap is a surgical procedure performed under general anesthesia. Historically, flap surgery has been associated with extended operative times. However, with the use of new surgical techniques, many of which Dr. Schwartz has helped to innovate, and in patients who are appropriate candidates, operative times for flap surgery have been significantly reduced. The average operative time for lumpectomy with perforator flap performed by Dr. Schwartz is approximately 1 hour.

Lumpectomy with perforator flap removes cancer and a small amount of the healthy tissue that surrounds it (margin). This ensures that all the abnormal tissue is removed. This tissue removal is followed by an immediate tissue rearrangement by Dr. Schwartz to avoid any breast deformity. In the case of cancer removal, the pathologist analyzes the margin removed by the lumpectomy to detect any possible cancer cells. A cancerous margin is “positive”, while a healthy margin is “clean” or “negative”. Another lumpectomy (re-excision lumpectomy) is performed if the margin is detected to be positive or cancerous cells are very close to the margin. It has been reported that up to 20% of women having a lumpectomy require re-excision lumpectomy. Dr. Schwartz’s matriculate approach reduces this number to only 10% or less for his practice. Dr. Schwartz follows national guidelines for negative margins.

For patients undergoing cancer removal, Sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) may be used to determine if cancer has progressed away out of the breast and into other parts of the body.

Recovery and Results

Patients after lumpectomy are discharged home the same day.

Healing time varies but after a lumpectomy with perforator flap.  You will probably feel weak right after the surgery, and you may feel pain for 2 to 3 weeks. You will be sore in the breast and in the area where the flap was taken. You may have a pulling or stretching feeling in those areas. You can expect to feel better and stronger each day, although you may need pain medicine for a week or two. You may get tired easily or have less energy than usual. This may last for several weeks after surgery.

You will likely have several drains near your incision. These help with healing. The drains will be removed when the fluid buildup slows. Drains are usually removed in the first few weeks after surgery.

You are likely to feel well enough to return to work after two weeks. You can usually resume normal physical activities at that time. 

Scarring is discretely hidden in the bra line. Just like the pathology report you received after your biopsy, you will also receive a pathology report after a lumpectomy. The results of your pathology report will probably be ready 3 to 7 days after your surgery. Once all the results are in, Dr. Schwartz will review the pathology report with you at the next office visit and discuss the next steps.