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Our First 101 Profunda Artery Perforator (PAP) Flaps for Breast Reconstruction
Constance M. Chen, MD, MPH1, Maria LoTempio, MD1, Robert J. Allen, MD2.
1New York Eye & Ear Infirmary, New York, NY, USA, 2New York University, New York, NY, USA.
PURPOSE: Autologous breast reconstruction appeals to many women undergoing mastectomies, but the procedure requires adequate donor site tissue. Recently, the profunda artery perforator (PAP) flap, which uses the skin and fat of the posterior thigh, has emerged as an excellent donor site for perforator flap breast reconstruction in thin women. The vascular pedicle has adequate length and caliber, the tissue is soft and pliable, and the donor site scar is well-concealed in the inferior gluteal crease. The objective of this study is to delineate specific refinements in technique and evaluate aesthetic and functional results.
METHODS: Over a 2-year period (2010-2012), we performed 101 PAP flaps for microsurgical breast reconstruction. PAP flap breast reconstruction was performed for the following indications: insufficient abdominal tissue, previous abdominal liposuction or surgery, failed TRAM/DIEP/SIEA, pear-shaped body habitus, or patient preference for a
non-abdominal donor site. Patient characteristics analyzed included age, body mass index (BMI), timing of reconstruction, and reason for reconstruction. Outcome variables included donor site dehiscence, posterior thigh numbness, seroma, hematoma, and infection. Specific advancements in technique to avoid posterior thigh numbness, donor site dehiscence, and scar migration are described to maximize functional outcome and aesthetic result.
RESULTS: A total of 101 flaps were performed in 58 patients (unilateral=16, 28%; bilateral=42, 72%). Average patient age was 48.2 years (range 24-69 years). Average BMI was 22.43 (range 16.3-38.4). Out of 101 flaps, 44 flaps were delayed reconstructions (43.6%) and 57 flaps were immediate reconstructions (56.4%); 61 flaps were for breast cancer treatment (60.3%), 37 flaps were prophylactic (36.6%); 3 flaps were for Poland’s syndrome (3%). Free-flap survival was 99%, with 1 flap loss (1%). There were 4 reexplorations (4%) due to vascular compromise (3%) and 1 hematoma (1%). Five patients suffered posterior donor site dehiscence (8.6%), 7 patients complained of posterior thigh numbness (12%), 3 patients developed a seroma (5%), 1 patient developed a hematoma (1%), 1 patient developed a donor site infection (1%).
CONCLUSION: The PAP flap is a safe, effective and reliable way to restore an aesthetically pleasing form to the female breast. For autologous breast reconstruction, the most common donor site is still the abdomen. When the abdomen is insufficient or not available, however, the PAP flap is our second choice for breast reconstruction. We feel that the PAP flap is a viable technique for autologous tissue breast reconstruction that may be easier to master than the other perforator flap procedures. In conclusion, we recommend the PAP flap as a simple and reliable perforator flap for microsurgical breast reconstruction.
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