{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:26:57Z","timestamp":1760059617818,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Intercostal artery perforator (ICAP) flaps are a reliable option for volume replacement in breast-conserving surgery (BCS), particularly for lower pole defects. However, limited flap volume may reduce their applicability in selected patients. Autologous fat grafting has been proposed to enhance both volume and aesthetic outcomes. Methods: This retrospective study evaluated 10 patients undergoing BCS with immediate reconstruction using fat-graft-augmented ICAP flaps. Nine anterior ICAP (AICAP) flaps and one lateral ICAP (LICAP) flap were employed. The outcomes included flap viability, complications, and aesthetic results over a 6-month follow-up. Results: Partial flap resorption occurred in 2 patients (20%), both of whom were active smokers. No cases of skin necrosis were observed. Fat grafting volumes ranged from 20 to 60 cc. Aesthetic outcomes were satisfactory, with good restoration of the breast contour and stable integration of the flap and grafted fat. Conclusions: The combined use of ICAP flaps and autologous fat grafting is a feasible and effective technique for immediate reconstruction after BCS. It allows volume enhancement, maintains natural contour, and shows low complication rates in properly selected patients. Smoking remains a significant risk factor.<\/jats:p>","DOI":"10.3390\/life15071017","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T03:39:59Z","timestamp":1750909199000},"page":"1017","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immediate Breast Reconstruction with Fat-Graft-Augmented ICAP Flaps"],"prefix":"10.3390","volume":"15","author":[{"given":"Francesco","family":"Klinger","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Ospedale San Paolo, University of Milan, via Antonio di Rudin\u00ec 8, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia Federico","family":"Cavallero","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Reconstructive and Aesthetic Plastic Surgery School, Universit\u00e0 degli Studi Di Milano, via Festa del Perdono 7, 20122 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2134-5633","authenticated-orcid":false,"given":"Andrea Vittorio Emanuele","family":"Lisa","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Reconstructive and Aesthetic Plastic Surgery School, Universit\u00e0 degli Studi Di Milano, via Festa del Perdono 7, 20122 Milan, Italy"},{"name":"Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20139 Milan, Italy"},{"name":"Department of Surgical Sciences, University of Rome \u201cTor Vergata\u201d, Cracovia n. 50, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7579-0794","authenticated-orcid":false,"given":"Fernando","family":"Rosatti","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20139 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Catania","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Klinger","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Reconstructive and Aesthetic Plastic Surgery School, Universit\u00e0 degli Studi Di Milano, via Festa del Perdono 7, 20122 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8435-8672","authenticated-orcid":false,"given":"Riccardo","family":"Di Giuli","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Furlan","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Reconstructive and Aesthetic Plastic Surgery School, Universit\u00e0 degli Studi Di Milano, via Festa del Perdono 7, 20122 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Comunian","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Reconstructive and Aesthetic Plastic Surgery School, Universit\u00e0 degli Studi Di Milano, via Festa del Perdono 7, 20122 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2327-1810","authenticated-orcid":false,"given":"Stefano","family":"Vaccari","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Reconstructive and Aesthetic Plastic Surgery School, Universit\u00e0 degli Studi Di Milano, via Festa del Perdono 7, 20122 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeriano","family":"Vinci","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/01.sap.0000222569.59581.d9","article-title":"Mastopexy with autologous augmentation after massive weight loss: The intercostal artery perforator (ICAP) flap","volume":"57","author":"Kwei","year":"2006","journal-title":"Ann. 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