Mapping internal and lateral anterior intercostal artery perforator flaps with colour Doppler ultrasound: correlation between preoperative imaging and intraoperative findings in oncoplastic breast surgery.

[PURPOSE] Anterior intercostal artery perforator (AICAP) flaps are valuable options for partial breast reconstruction, requiring reliable identification of dominant perforators for safe flap design. This study aimed to evaluate the agreement between preoperative high-frequency colour Doppler ultrasound (CDUS) findings and intraoperative anatomy of internal and lateral intercostal perforators, and to map their anatomical distribution.

[METHODS] Sixty-four patients undergoing breast-conserving surgery were examined using high-frequency CDUS. The region from the midline to the mid-axillary line and from the fourth intercostal space to 4 cm below the inframammary fold was systematically scanned. Dominant perforators were measured, marked, and intraoperatively reassessed in 24 patients undergoing AICAP flap reconstruction. Vessel diameters, location, and additional perforators were recorded and spatial distribution was analysed.

[RESULTS] Preoperative CDUS identified lateral perforators as larger than internal (2.08 mm vs. 1.61 mm, p < 0.01), confirmed intraoperatively (1.69 mm vs. 1.10 mm, p < 0.01). Dominant perforators were located 3.63 cm lateral to the patient's midline and 1.32 cm inferior to the IMF (internal), and 0.53 cm medial to the anterior axillary line and 0.95 cm inferior to the IMF (lateral). In both internal and lateral regions, supplementary vessels were detected near the dominant perforators, contributing to increased perfusion security.

[CONCLUSIONS] High-frequency CDUS enables reproducible preoperative localisation of dominant IAICAP and LAICAP perforators and shows high agreement with intraoperative findings. Standardised ultrasound mapping may support structured flap planning and intraoperative orientation in oncoplastic breast reconstruction.