Introduction Breast conserving surgery has good oncological outcomes for selected breast cancers and may result in superior cosmetic outcomes. Traditionally used for smaller tumours, utilisation has expanded with the development of oncoplastic techniques such as local perforator flaps. This study describes the experience of introducing an intercostal perforator flap service at a tertiary hospital in Western Australia. Methods This case series used retrospectively collected data on patients who underwent breast conserving surgery with intercostal perforator flap reconstruction at Sir Charles Gairdner Hospital between May 2023 and September 2025. Data collected included flap type, tumour characteristics, complications, and re-operation rates. Pre-operative tumour size on imaging was compared with final histological size using Student’s t-test. Results 28 consecutive patients were included, with all reconstructions performed immediately. The mean operative time was 122 minutes (range 60–245). Flaps were most commonly based on the lateral intercostal perforator, with 28.6% of cases utilising dual-perforator supply. The median specimen weight was 38.6 g (range 18.6–250 g). Mean tumour size was 28.3 mm on both pre-operative imaging and final histology, with no statistically significant difference. Four patients underwent surgery for ductal carcinoma in situ alone, while the remainder had invasive cancer ranging from T1–T3 tumours.18 patients underwent concurrent sentinel lymph node biopsy while 6 had axillary clearance. Margin re-excision was required in four patients (14.3%) and post-operative infection occurred in six patients (21.4%), half of whom required procedural intervention. There were no post-operative haematomas or complete flap losses. Conclusion The introduction of an intercostal perforator flap service enabled breast conserving surgery for a broad range of tumour sizes and pathologies with acceptable operative times and key performance indicators.