**6.4 Level 3: volume replacement (local perforator flaps in partial breast reconstruction)**

Another reconstructive option following breast conservative surgery is volume replacement (level 3 oncoplastic breast conservative surgery). The technique is the ideal choice if a large resection volume is required in a small volume breast and a patient desires to avoid mastectomy. It is also a good alternative for a large resection volume in a large volume breast, but in a patient wishing to avoid additional procedures for symmetry in a contralateral healthy breast. Moreover, it is a useful option for the correction of deformity following unsuccessful previous BCS.

The flaps utilised in partial breast reconstruction can be harvested as random or perforator-based flaps. The irrigation of the flap is based on nearby perforator arteries: medial, anterior, and lateral intercostal arteries perforators (MICAP, AICAP, LICAP), lateral thoracic artery perforators (LTAP) and thoracodorsal artery perforators (TDAP). These adipo-cutaneous flaps may be designed in the epigastric area, just below to IMF or in the lateral thoracic region, connected to a lateral mammary crease, and therefore can be easily inserted in a breast defect following tumour resection (**Figure 5**). However, additional scars, donor site morbidity and a higher risk of complications associated with these techniques mandate additional surgical training, as well as appropriate patient selection. A detailed description of the techniques is available widely across the literature [42–46] and is beyond the scope of this chapter.

**Figure 5.**

*Local perforator flaps for partial breast reconstruction harvested in a) epigastric region and b) lateral thoracic region.*
