Download PDF
J Reconstr Microsurg 2022; 38(01): 027-033
DOI: 10.1055/s-0041-1727200
Original Article

The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients

Taehee Jo
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Dong Nyeok Jeon
2   Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Seoul, Korea
,
Hyun Ho Han 
2   Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Seoul, Korea
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated.

Methods Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. PAP flap breast reconstructions were compared with standard deep inferior epigastric perforator (DIEP) flap breast reconstructions, and were grouped into single or stacked PAP flaps for further analysis.

Results Overall, 43 PAP flaps were performed to reconstruct 32 breasts. Eleven patients underwent stacked PAP flap reconstruction, while 17 patients underwent 21 single PAP flap reconstruction. The average body mass index (BMI) of the patients was 22.2 ± 0.5 kg/m2. The results were as follows: no total loss, one case of venous congestion (2.3%), two donor site wound dehiscence cases (4.7%), and one case of fat necrosis from partial flap loss (2.3%). When compared with 192 DIEP flap reconstructions, the final DIEP flap supplied 98.1 ± 1.7% of mastectomy weight, while the final PAP flap supplied 114.1 ± 6.2% of mastectomy weight (p < 0.005), demonstrating that PAP flaps can successfully supply final reconstruction volume. In a separate analysis, single PAP flaps successfully supplied 104.2% (84.2-144.4%) of mastectomy weights, while stacked PAP flaps supplied 103.7% (98.8-115.2%) of mastectomy weights.

Conclusion In our series of PAP flap reconstructions performed in low-to-normal BMI patients, we found that PAP flaps, as single or stacked flaps, provide sufficient volume to reconstruct mastectomy defects.

Keywords

profunda artery perforator - deep inferior epigastric perforator - flap


Publication History

Received: 21 October 2020

Accepted: 16 February 2021

Article published online:
14 April 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 2 Dayan JH, Allen Jr RJ. Lower extremity free flaps for breast reconstruction. Plast Reconstr Surg 2017; 140 (5S Advances in Breast Reconstruction) 77S-86S
    CrossrefPubMedGoogle Scholar
  • 3 Allen RJ, Tucker Jr C. Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 1995; 95 (07) 1207-1212
    CrossrefPubMedGoogle Scholar
  • 4 LoTempio MM, Allen RJ. Breast reconstruction with SGAP and IGAP flaps. Plast Reconstr Surg 2010; 126 (02) 393-401
    CrossrefPubMedGoogle Scholar
  • 5 Paletta CE, Bostwick III J, Nahai F. The inferior gluteal free flap in breast reconstruction. Plast Reconstr Surg 1989; 84 (06) 875-883
    CrossrefPubMedGoogle Scholar
  • 6 Shaw WW. Superior gluteal free flap breast reconstruction. Clin Plast Surg 1998; 25 (02) 267-274
    CrossrefPubMedGoogle Scholar
  • 7 Buchel EW, Dalke KR, Hayakawa TE. The transverse upper gracilis flap: Efficiencies and design tips. Can J Plast Surg 2013; 21 (03) 162-166
    CrossrefPubMedGoogle Scholar
  • 8 Craggs B, Vanmierlo B, Zeltzer A, Buyl R, Haentjens P, Hamdi M. Donor-site morbidity following harvest of the transverse myocutaneous gracilis flap for breast reconstruction. Plast Reconstr Surg 2014; 134 (05) 682e-691e
    CrossrefPubMedGoogle Scholar
  • 9 Yousif NJ. The transverse gracilis musculocutaneous flap. Ann Plast Surg 1993; 31 (04) 382
    CrossrefPubMedGoogle Scholar
  • 10 Yousif NJ, Matloub HS, Kolachalam R, Grunert BK, Sanger JR. The transverse gracilis musculocutaneous flap. Ann Plast Surg 1992; 29 (06) 482-490
    CrossrefPubMedGoogle Scholar
  • 11 Schoeller T, Huemer GM, Wechselberger G. The transverse musculocutaneous gracilis flap for breast reconstruction: guidelines for flap and patient selection. Plast Reconstr Surg 2008; 122 (01) 29-38
    CrossrefPubMedGoogle Scholar
  • 12 Allen RJ, Haddock NT, Ahn CY, Sadeghi A. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg 2012; 129 (01) 16e-23e
    CrossrefPubMedGoogle Scholar
  • 13 Haddock NT, Cho M-J, Teotia SS. Comparative analysis of single versus stacked free flap breast reconstruction: a single-center experience. Plast Reconstr Surg 2019; 144 (03) 369e-377e
    CrossrefPubMedGoogle Scholar
  • 14 Haddock NT, Gassman A, Cho MJ, Teotia SS. 101 consecutive profunda artery perforator flaps in breast reconstruction: lessons learned with our early experience. Plast Reconstr Surg 2017; 140 (02) 229-239
    CrossrefPubMedGoogle Scholar
  • 15 Haddock NT, Teotia SS. Consecutive 265 profunda artery perforator flaps: refinements, satisfaction, and functional outcomes. Plast Reconstr Surg Glob Open 2020; 8 (04) e2682
    CrossrefPubMedGoogle Scholar
  • 16 Kim SW, Han HH, Seo JW. et al. Two cases of lower body contouring with a spiral and vertical medial thigh lift. Arch Plast Surg 2012; 39 (01) 67-70
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Gassman AA, Yoon AP, Maxhimer JB. et al. Comparison of postoperative pain control in autologous abdominal free flap versus implant-based breast reconstructions. Plast Reconstr Surg 2015; 135 (02) 356-367
    CrossrefPubMedGoogle Scholar
  • 18 Ludolph I, Horch RE, Harlander M. et al. Is there a rationale for autologous breast reconstruction in older patients? A retrospective single center analysis of quality of life, complications and comorbidities after DIEP or MS-TRAM flap using the BREAST-Q. Breast J 2015; 21 (06) 588-595
    CrossrefPubMedGoogle Scholar
  • 19 Allen Jr RJ, Lee ZH, Mayo JL, Levine J, Ahn C, Allen Sr RJ. The profunda artery perforator flap experience for breast reconstruction. Plast Reconstr Surg 2016; 138 (05) 968-975
    CrossrefPubMedGoogle Scholar
  • 20 Jo T, Kim EK, Eom JS, Han HH. Comparison of transverse upper gracilis and profunda femoris artery perforator flaps for breast reconstruction: a systematic review. Microsurgery 2020; 40 (08) 916-928
    CrossrefPubMedGoogle Scholar
  • 21 Zaussinger M, Tinhofer IE, Hamscha U. et al. A head-to-head comparison of the vascular basis of the transverse myocutaneous gracilis, profunda artery perforator, and fasciocutaneous infragluteal flaps: an anatomical study. Plast Reconstr Surg 2019; 143 (02) 381-390
    CrossrefPubMedGoogle Scholar
  • 22 Greige N, Nash D, Salibian AA. et al. Estimation of profunda artery perforator flap weight using preoperative computed tomography angiography. J Reconstr Microsurg 2020; 36 (09) 645-650
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Hunsinger V, Lhuaire M, Haddad K. et al. Medium- and large-sized autologous breast reconstruction using a fleur-de-lys profunda femoris artery perforator flap design: a report comparing results with the horizontal profunda femoris artery perforator flap. J Reconstr Microsurg 2019; 35 (01) 8-14
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Scaglioni MF, Chen YC, Lindenblatt N, Giovanoli P. The vertical posteromedial thigh (vPMT) flap for autologous breast reconstruction: a novel flap design. Microsurgery 2017; 37 (05) 371-376
    CrossrefPubMedGoogle Scholar
  • 25 Hammond JB, Flug JA, Foley BM. et al. A newly described, highly prevalent arterial pedicle perfuses both gracilis and profunda artery perforator flap tissues: an angiographic study of the medial thigh. J Reconstr Microsurg 2020; 36 (03) 177-181
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Cho MJ, Teotia SS, Haddock NT. Classification and management of donor-site wound complications in the profunda artery perforator flap for breast reconstruction. J Reconstr Microsurg 2020; 36 (02) 110-115
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 DeLong MR, Hughes DB, Bond JE, Thomas SM, Boll DT, Zenn MR. A detailed evaluation of the anatomical variations of the profunda artery perforator flap using computed tomographic angiograms. Plast Reconstr Surg 2014; 134 (02) 186e-192e
    CrossrefPubMedGoogle Scholar
  • 28 Wong C, Nagarkar P, Teotia S, Haddock NT. The profunda artery perforator flap: investigating the perforasome using three-dimensional computed tomographic angiography. Plast Reconstr Surg 2015; 136 (05) 915-919
    CrossrefPubMedGoogle Scholar