Breast reconstruction with the extended profunda artery perforator flap

Tielemans, H.J.P.; Kuppenveld, Phoebe I.P. van; Winters, Harm; Hupkens, Pieter; Ulrich, Dietmar; Hummelink, Stefan

doi:10.1016/j.bjps.2020.08.109

Cited by 16 publications

(11 citation statements)

References 11 publications

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“…Nonetheless, since the enrolled patients in this study had a smaller BMI, a smaller flap makes sense. The pedicle length of our PAP flaps was 4-10 cm compared to 9-11 cm in the literature (Allen et al, 2012;Hunsinger et al, 2019;Tielemans et al, 2021), and this may be attributed to the shorter stature of the Asian population. Even so, the pedicle length did not affect flap shaping in our case series except in one patient who required a vein graft due to her ptotic breast shape.…”

Section: Discussionmentioning

confidence: 59%

Small flaps in microsurgical breast reconstruction: Selection between the profunda artery perforator and small deep inferior epigastric artery perforator flaps and associated outcomes and complications

et al. 2023

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BackgroundThe deep inferior epigastric artery perforator (DIEP) flap is widely used in breast reconstruction and the profunda artery perforator (PAP) flap as alternative. However, the difference between the two flaps in smaller breast reconstruction remains lacking, in particular, the donor site complications. In this case series, the results of small breast reconstruction (≤300 g) using PAP or small DIEP flaps were explored.MethodsUnilateral immediate breast reconstruction using a free PAP flap or small DIEP flap (≤300 g) from 2011 to 2021 were reviewed retrospectively. Excluding patients with delayed reconstruction, 28 patients, including 17 PAP flaps and 11 small DIEP flaps were enrolled. Flap characteristics, breast and donor site complications, and revision surgeries were reviewed. BREAST‐Q™ was used for quality‐of‐life assessment.ResultsCompared with a small DIEP flap, a PAP flap was narrow (7.5 ± 1.1 vs. 10.6 ± 0.7 cm, p < .001), short (20.0 ± 2.6 vs. 25.5 ± 1.8 cm, p < .001) and had a shorter pedicle (5.9 ± 1.6 vs. 9.1 ± 1.0 cm, p < .001). There were no significant differences in acute and late complications of wound healing and fat necrosis, but the average number of revisions in the PAP group was significantly higher (1.9 ± 1.3 vs. 0.8 ± 1.4, p = .041). Patient‐reported outcomes using BREAST‐Q™ displayed no significant difference between the two groups.ConclusionThe outcomes of PAP and small DIEP flaps at the breasts and donor sites are satisfactory, despite that a higher tendency of donor site complications in PAP flap and more aesthetic refinement required in the PAP group. The overall outcomes are acceptable.

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Section: Discussionmentioning

confidence: 59%

Small flaps in microsurgical breast reconstruction: Selection between the profunda artery perforator and small deep inferior epigastric artery perforator flaps and associated outcomes and complications

et al. 2023

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“…The authors stated that the vast majority of their patients underwent revision procedures, mainly consisting in fat grafting to improve the donor and recipient sites contour. Tielemans et al 21 recently reported their experience with the extended PAP flap for breast reconstruction, whose design is very similar to the already described trilobed PAP flap 22 . They it allows to recruit more skin and subcutaneous tissues on a dominant distal perforator.…”

Section: Discussionmentioning

confidence: 86%

Breast reconstruction using the profunda artery perforator (PAP) flap: Technical refinements and evolution, outcomes, and patient satisfaction based on 116 consecutive flaps

Atzeni¹,

Salzillo²,

Haywwod³

et al. 2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…Thus, a large area of undermined skin is created by placing the scar in the thigh crease, favoring the mentioned complications. In order to gain more volume, alterations of flap geometry have been suggested [22], alternatively extended [23], or even stacked and chimeric [24, 25] flaps could be used. However, the easiest and most straightforward method to gain flap volume seems to be harvesting a skin paddle as wide as possible and to include adjacent fat tissue, thus, even thinning the undermined soft tissues in the donor region.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome Analysis and Technical Refinements after Autologous Breast Reconstruction with PAP Flap: What We Have Learnt

et al. 2022

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Introduction: The profunda artery perforator (PAP) flap represents a valuable alternative to the deep inferior epigastric artery perforator flap which, nowadays, is considered the golden standard for autologous breast reconstruction. The goal of this study was to evaluate the long-term satisfaction, functional outcomes of the donor site following PAP flap-based breast reconstruction and to present our personal learning experience along with suggestions for technique refinements. Methods: In this prospective single-center appraisal, 18 patients who underwent PAP flap-based breast reconstruction between January 2016 and November 2019 were enrolled. The Patient and Observer Scar Assessment Scale (POSAS) and the Breast-Q questionnaire were employed to evaluate the results 12 months postoperative. Data were analyzed with the Q-Score program. Complications were recorded in the medical database and classified with the Clavien-Dindo classification. Results: In the questionable time frame, 164 female patients underwent free flap breast reconstruction. Of those, 18 patients that received PAP flaps (9 bilateral) were included in this study. We recorded one flap loss because of venous failure. Most complications concerned the donor site, including hematoma, seroma, and wound healing problems. Patients’ satisfaction was high at 12 months post-surgery, despite critical evaluation of the donor site scar. Conclusion: The PAP flap serves as an excellent option for breast reconstruction in patients who do not have abundant abdominal tissue. The overall clinical outcome was good and patients’ evaluation showed high satisfaction after 12 months despite high complication rates. Modifications in planning and flap harvesting might improve the donor site outcome and the overall complication rate.

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Breast reconstruction with the extended profunda artery perforator flap

Cited by 16 publications

References 11 publications

Small flaps in microsurgical breast reconstruction: Selection between the profunda artery perforator and small deep inferior epigastric artery perforator flaps and associated outcomes and complications

Small flaps in microsurgical breast reconstruction: Selection between the profunda artery perforator and small deep inferior epigastric artery perforator flaps and associated outcomes and complications

Breast reconstruction using the profunda artery perforator (PAP) flap: Technical refinements and evolution, outcomes, and patient satisfaction based on 116 consecutive flaps

Long-Term Outcome Analysis and Technical Refinements after Autologous Breast Reconstruction with PAP Flap: What We Have Learnt

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