Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 115845

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : November | Volume : 17 | Issue : 11 | Page : XC01 - XC03 Full Version

Modified Lateral Intercostal Artery Perforator Flap in Immediate Partial Breast Reconstruction for Breast Cancer: A Retrospective Cohort Study

Published: November 1, 2023 | DOI:
Kalai Chelvi Arumugam Ilambirai, Suhaildeen Kajamohideen, Balasubramanian Venkitaraman, Sathyanarayanan M Shivkumaran, Prithviraj Premkumar, Jagadesh Chandra Bose Soundarajan

1. Senior Resident, Department of General Surgery, Sri Lalithambigai Medical College and Hospital, Chennai, Tamil Nadu, India. 2. Assistant Professor, Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. 3. Associate Professor, Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. 4. Assistant Professor, Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. 5. Assistant Professor, Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. 6. Professor, Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. Suhaildeen Kajamohideen,
Assistant Professor, Department of Surgical Oncology, Sri Ramachandra Medical College and Research Institute, Chennai-600116, Tamil Nadu, India.


Introduction: The primary surgical options for treating breast cancer involve mastectomy or Breast Conservative Surgery (BCS), which may or may not include reconstruction procedures. BCS helps achieve complete tumour excision with an acceptable cosmetic result. Contour deformities and asymmetry are associated with tissue excision in the lateral aspect of the breast. To address this issue, various techniques of volume replacement, such as the modified Lateral Intercostal Artery Perforator (LICAP) flap, can be performed.

Aim: To demonstrate the outcomes of a modified LICAP flap when a muscle flap is not available or desired.

Materials and Methods: A retrospective cohort study was conducted, reviewing all modified LICAP flaps performed for breast tumours in Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, a tertiary-level cancer centre, from June 2018 to August 2020. Patient demographics, surgical details, histopathology reports, and postoperative complications were collected.

Results: Ten patients underwent modified LICAP flaps over a two-year period. All patients had pT2 tumours with margin-negative resection, and the mean resection volume of the specimen was 370 cm3. Intraoperative patient repositioning was not necessary during the modified LICAP flap procedure. One patient experienced marginal wound necrosis, which was managed conservatively. No patients had scars extending beyond the posterior axillary line, and axillary dissection was performed without a separate incision.

Conclusion: The present study demonstrates the advantages of using a modified LICAP flap for breast reconstruction. The modified LICAP flap can be considered as an option for tumours located in the outer aspect of the breast, providing good access to the breast as well as the axilla, with an aesthetically acceptable scar.


Breast conservation, Carcinoma breast, Mastectomy

Modified radical mastectomy with or without reconstruction or BCS are the main treatment options for breast cancer. With a better understanding and implementation of oncoplastic techniques, the complexity of these BCS and reconstruction procedures is increasing. BCS has comparable survival rates to mastectomy when paired with adjuvant radiotherapy. Tumour factors, patient body habitus, co-morbidities, and patient wishes are taken into consideration when offering BCS as a treatment option (1).

Standard oncoplastic techniques involve volume displacement, resulting in a significant difference in the size of the breast, sometimes requiring contralateral reduction mammoplasty to achieve symmetry. In patients who initially have nearly symmetrical breasts preoperatively, volume replacement techniques can be performed instead of volume displacement techniques to maintain symmetry. The evolution of volume replacement oncoplastic techniques has progressed from musculocutaneous to fasciocutaneous flaps, and currently involves the use of perforator-based flaps composed solely of skin and subcutaneous tissue. The LICAP flap, as described by Hamdi M et al., stands out as an excellent method of volume replacement technique, relying on perforating arteries originating within the costal segment of the intercostal arteries (2).

The original LICAP flap described by Hamdi M et al., had two limitations. There was a need to reposition the patient to harvest the flap, and the scar extended from the lateral mammary fold to a point 5 cm behind the posterior axillary line, making the scar quite visible (2). To address these limitations, the LICAP technique was modified, and this article assesses the surgical technique, patient and tumour characteristics, and any postoperative complications of breast reconstruction using a modified LICAP flap.

Material and Methods

A retrospective cohort study was conducted, reviewing all patients who underwent the modified LICAP flap procedure along with BCS from June 2018 to August 2020 at Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, a tertiary-level cancer centre.

Study Procedure

The patients were identified from a prospectively maintained database. The LICAP flap procedure had been performed on breast tumours in the upper and outer quadrants. Patient demographics, details of surgery, histopathology results, and any postoperative complications following the modified LICAP flap were collected and tabulated.

Surgical anatomy: The lateral chest roll, extending laterally from the breast, comprises both the skin and adipose tissue situated alongside the inframammary crease. To reconstruct the breast mound without an implant, a large chest fold can provide adequate tissue. Even when a distinct lateral fold is not clearly defined, it is still possible to harvest the flap since there is some a degree of excess skin in the upper back. The LICAP flap is based on the skin and subcutaneous pedicle containing analogous perforators, which are present more laterally in the inframammary fold. There are usually 2 to 5 lateral intercostal perforator arteries located within a range of 6 to 8 cm from the midaxillary line, based on the dissection studies conducted by Hamdi M et al., (2),(3),(4). The portion of the fold present within 6 to 8 cm of the midaxillary line represents the flap pedicle, which can be rotated 180°. A single perforator bundle measuring more than 0.5 cm in diameter is sufficient to provide blood supply to the flap, as indicated by Hamdi M et al., based on cadaver dissections. In 90% of the dissections, lateral intercostal perforators were found 2.67 to 3.49 cm from the anterior border of the latissimus dorsi muscle (3),(5).

Surgical technique: Prior to surgery, preoperative marking is performed to identify external landmarks, including the mid-axillary line, the lateral edge of the latissimus dorsi muscle, the inframammary fold, and its extension as the lateral chest fold. The anterior part of the incision is a continuation of the inframammary crease along the lateral aspect of the breast. Based on the redundancy of the lateral skin fold, another line is drawn elliptically in a posterior direction along the midaxillary line, completing the outline of the flap. This design ensures that the pedicle consistently includes cutaneous perforators from the intercostal vessels (Table/Fig 1),(Table/Fig 2) (2),(3),(4). The flap’s skin is de-epithelialised.

The skin flap is raised along the anterior border of the flap, and a wide local excision of the breast primary is performed. From the superior border of the flap, axillary dissection is completed, providing excellent access to both the breast and axilla. Clips are placed for marking within the cavity of the wide local excision. Once the dissection is complete, the flap is rotated 180 degrees to fill the defect and concealed within the skin envelope to provide a vascularised volume. The flap is supported with deep dermal and subcuticular sutures in its new location before closing the wound with a suction drain (Table/Fig 2).


Ten patients underwent BCS and modified LICAP flap between June 2018 and August 2020. The patient characteristics are summarised in (Table/Fig 3). All patients underwent preoperative multidisciplinary tumour board discussions. They all had a biopsy-proven breast carcinoma before surgery and were scheduled for initial surgery.

Out of the 10 patients, seven had tumour located in the upper outer quadrant, two had tumours in the upper quadrants at the 12 o’clock position, and one had a tumour in the lower outer quadrant. Seven patients had luminal B tumour biology, two had basal-like subtype, and one had Her-2 enriched tumour.

All patients had a pathological T stage of pT2, and the size of the excised tumour ranged from 2 cm to 4 cm (median size 2.9 cm), with clear margins. Axillary dissection and modified LICAP flap were performed in the same sitting. Five patients had pN0 nodal status, four had pN1a, and one had pN3a nodal staging. The volume of the breast specimen ranged from 140 cm3 to 600 cm3 (median 370 cm3).

The median postoperative stay was 48 hours, and the average duration of surgery was 120 minutes. None of the patients required perioperative blood transfusion. All patients were taught shoulder exercises and advised to continue them at home.

There were no perioperative mortalities. The drains were removed by the 10th day (range 8-14 days). No postoperative seroma infections were reported. One patient developed wound marginal necrosis and required debridement and resuturing. All patients underwent adjuvant chemotherapy and sequential radiotherapy and are currently on regular follow-up. The median duration of follow-up was 18 months, ranging from 6 to 30 months.


The primary goal of BCS is to achieve complete cancer removal with clear margins while also obtaining a favourable aesthetic outcome. Several factors influence the outcome and risk of complications, including the ratio of excised tissue volume to breast volume, tumour location, density of the glandular breast tissue, and the condition of the skin covering the area (1),(6),(7).

In traditional BCS for a large tumours in the upper outer quadrant, there is a potential risk of the nipple-areola complex experiencing deviation, which becomes more noticeable following radiotherapy, leading to contour deformity or depression in the breast parenchyma. Balancing the oncological requirement for wider excision with the patient’s desire for a pleasing aesthetic outcome can pose a significant challenge in standard BCS. These irregularities and imbalances in breast appearance have been documented as contributing factors to negative body image and reduced quality of life (8),(9),(10).

Oncoplastic breast surgery integrates the principles of both oncology and reconstructive surgery to achieve optimal results that are both oncologically sound and aesthetically pleasing. Oncoplastic procedures enable the removal of larger tumours relative to breast size, reduce the occurrence of positive margins, and the need for redo surgeries, while maintaining and improving the shape, symmetry, and cosmetic appeal of the breast (11).

To address these aesthetic problems, oncoplastic techniques with or without contralateral reduction procedures have been developed (12). In a retrospective review by Wijesinghe K et al., oncoplastic breast surgeries were shown to have wider surgical margins, decreased need for re-excision, better aesthetic outcomes, and similar operative times and complication rates (13). The LICAP flap, a perforator-based flap, has been added to the armamentarium of oncoplastic breast surgeries. The modified LICAP flap, initially described by Meybodi F et al., (3), offers several advantages over the traditional LICAP flap, including the elimination of the need for intraoperative patient repositioning and the achievement of a cosmetically pleasing scar. These perforator flaps do not alter the inframammary fold, and there is no need for skeletonisation of the perforator pedicle. In comparison to Meybodi F et al., the present flap was fashioned close to the anterior axillary line, resulting in a scar hidden by the breast and not extending into the axilla (Table/Fig 4) (3). Even in patients with tumours close to the upper inner quadrant at the 12 o’clock position, adequate exposure was provided by the incision for wide excision. The de-epithelialised skin placed under the skin flap contributes to the uniformity of the reconstruction, and the resultant scar is along the anterior axillary line. The volume replacement technique also enables BCS in patients with a large tumour volume to breast volume ratio. The modified LICAP technique is particularly suitable for women who wish to maintain their breast shape and size and who have excess tissue lateral to the breast and skin laxity.


The study has certain limitations, including its small sample size, which necessitates further assessment of patient satisfaction when comparing it with volume displacement oncoplastic techniques.


The volume replacement technique, such as the modified LICAP flap, provides immediate reconstruction of defects in the lateral aspect of the breast following BCS. The Modified LICAP flap also allows excellent exposure of the axilla and avoids the need for intraoperative patient repositioning, while also offering an aesthetically acceptable scar.


Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227-32. [crossref][PubMed]
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 Aesthetic Surg JPRAS. 2006;59(6):644-52. [crossref][PubMed]
Meybodi F, Cocco AM, Messer D, Brown A, Kanesalingam K, Elder E, et al. The Modified Lateral Intercostal Artery Perforator Flap. Plast Reconstr Surg Glob Open [Internet]. 2019;7(2). Available from: articles/PMC6416140/. [crossref][PubMed]
Macmillan RD, McCulley SJ. Oncoplastic breast surgery: What, when and for whom? Curr Breast Cancer Rep. 2016;8:112-17. [crossref][PubMed]
Hamdi M, Van Landuyt K, Blondeel P, Hijjawi JB, Roche N, Monstrey S. Autologous breast augmentation with the lateral intercostal artery perforator flap in massive weight loss patients. J Plast Reconstr Aesthetic Surg JPRAS. 2009;62(1):65-70. [crossref][PubMed]
Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: A classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17(5):1375-91. [crossref][PubMed]
Blondeel PN, Hijjawi J, Depypere H, Roche N, Van Landuyt K. Shaping the breast in aesthetic and reconstructive breast surgery: An easy three-step principle. Part III--Reconstruction following breast conservative treatment. Plast Reconstr Surg. 2009;124(1):28-38. [crossref][PubMed]
Pukancsik D, Kelemen P, Ăšjhelyi M, Kovács E, Udvarhelyi N, Mészáros N, et al. Objective decision making between conventional and oncoplastic breast-conserving surgery or mastectomy: An aesthetic and functional prospective cohort study. Eur J Surg Oncol (EJSO). 2017;43(2):303-10. [crossref][PubMed]
Santos G, Urban C, Edelweiss MI, Zucca-Matthes G, de Oliveira VM, Arana GH, et al. Long-term comparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol. 2015;22(8):2500-08. [crossref][PubMed]
Hakakian CS, Lockhart RA, Kulber DA, Aronowitz JA. Lateral intercostal artery perforator flap in breast reconstruction a simplified pedicle permits an expanded role. Ann Plast Surg. 2016;76(Suppl 3):S184-90. Doi: 10.1097/ SAP.0000000000000752. [crossref][PubMed]
Crown A, Wechter DG, Grumley JW. Oncoplastic breast-conserving surgery reduces mastectomy and postoperative re-excision rates. Ann Surg Oncol. 2015;22(10):3363-68. [crossref][PubMed]
Macmillan RD, James R, Gale KL, McCulley SJ. Therapeutic mammaplasty. J Surg Oncol. 2014;110(1):90-95. [crossref][PubMed]
Wijesinghe K, Abeywickrama T, Chamara Y, De Silva S, Tharshan S, Jayarajah U, et al. Oncoplastic breast conserving surgery versus standard breast conserving surgery for early and locally advanced breast cancer: A retrospective analysis from Sri Lanka. BMC Surg. 2023;23(1):273.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/63829.18678

Date of Submission: Feb 28, 2023
Date of Peer Review: Apr 27, 2023
Date of Acceptance: Sep 24, 2023
Date of Publishing: Nov 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Mar 14, 2023
• Manual Googling: May 12, 2023
• iThenticate Software: Sep 20, 2023 (20%)

ETYMOLOGY: Author Origin


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)