Download PDF
Semin Plast Surg
DOI: 10.1055/a-2781-5836
Review Article

Profunda Artery Perforator Flap for Autologous Breast Reconstruction: A Review of the Evidence and the Linkou Chang Gung Memorial Hospital Experience

Authors

  • David C.-F. Cheong

    1   Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    2   College of Medicine, Chang Gung University, Taoyuan, Taiwan
    3   Breast Cancer Center, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan

  • Chia-Fang Chen

    1   Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    2   College of Medicine, Chang Gung University, Taoyuan, Taiwan
    3   Breast Cancer Center, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan

  • Wen-Ling Kuo

    2   College of Medicine, Chang Gung University, Taoyuan, Taiwan
    3   Breast Cancer Center, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    4   Department of General Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    5   School of Medicine, National Tsing Hua University, Hsinchu, Taiwan

  • Jung-Ju Huang

    1   Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    2   College of Medicine, Chang Gung University, Taoyuan, Taiwan
    3   Breast Cancer Center, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Further Information
Also available at
   Permissions and Reprints

Abstract

This study aimed to summarize and highlight institutional experience on the profunda artery perforator (PAP) flap for autologous breast reconstruction. Contemporary series demonstrate high flap success and patient satisfaction with PAP reconstruction. Key technical evolutions include perforator-targeted skin paddle designs, strategies to augment venous outflow when needed, and standardized donor site management. Comparative studies and systematic reviews suggest reconstructive reliability comparable to other autologous options, while donor site wound morbidity remains the main area for optimization. In the low-body mass index (BMI) Asian cohort, PAP reconstruction achieved high success, and closed-incision negative pressure wound therapy (iNPWT) reduced donor site wound complications. The PAP flap is a versatile alternative when the abdomen is unsuitable, particularly for small-to-moderate volume breast reconstruction. Outcomes are optimized by careful patient selection, perforator mapping, thoughtful flap design, proactive venous outflow planning, and meticulous donor site closure. Stacked/Bilateral PAP strategies and staged fat grafting expand indications when a single flap is unlikely to meet volume requirements.

Keywords

autologous breast reconstruction - profunda artery perforator flap - PAP flap - low-body mass index - patient-reported outcomes - BREAST-Q


Publication History

Article published online:
02 February 2026

© 2026. Thieme. All rights reserved.

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