“Categorizing Patient Selection, Outcomes, and Indications in a Decade of 405 PAP Flaps”

Autologous tissue is the only permanent option for breast reconstruction. While abdominal tissue remains popular, considering alternative donor sites ensures comprehensive care tailored to a patient. The thigh has been established as an excellent choice in autologous reconstruction. We present a ten-year experience with 405 profunda artery perforator flaps (PAP flaps).An IRB approved ten-year retrospective review of all patients treated with PAP flaps for breast reconstruction was performed. Procedures were carried out by two surgeons at the same institution. PAP flaps were divided into four consecutive groups with approximately 100 flaps in each group. Demographics, indications, intraoperative data, post-operative complications, revisions, and patient reported outcomes were recorded and analyzed.207 patients (405 PAP flaps) were included. This accounted for 17.2% of all breast reconstruction flaps. 55% of patients underwent a multi-flap procedure. The average flap weight was 354.3 g (+/- 117.2), which significantly decreased over time (p<0.001). Rates of major complications were 9.6% wounds, 4.4% seromas, 4.7% hematomas, and 3.5% infections. Total flap loss was 2%, 67% of which were in stacked patients. Satisfaction routinely improved from pre-operative to post-operative.As available flap donor sites continue to evolve, tailoring breast reconstruction to the individual patient is standard in centers of excellence. The PAP flap has emerged as an excellent choice for autologous-based breast reconstruction through utilization of proper patient selection and surgical technique.