Consecutive 265 Profunda Artery Perforator Flaps: Refinements, Satisfaction, and Functional Outcomes

Introduction: The ideal form of breast reconstruction provides total permanent restoration of the breast mound. When a deep inferior epigastric (DIEP) flap is not an option or does not provide significant volume, a secondary source must be considered. In our practice, the profunda artery perforator (PAP flap) from the thigh has emerged as a second choice. We present our experience with the first 265 PAP flaps used for breast reconstruction at our institution. We specifically focus on refinements, satisfaction, and functional outcomes. Methods: We conducted a retrospective review of the first 265 PAP flaps at our institution. Patient demographics, perioperative data, and postoperative complications were recorded and analyzed. The Breast Q and Lower Extremity Functional Scale (LEFS) were both implemented. Additionally, a satisfaction survey was performed, particularly focused on the donor site. Results: Two hundred sixty-five consecutive PAP flaps were used to reconstruct 244 breasts in 138 patients. The PAP flap was used for bilateral reconstruction (107 patients) and unilateral breast (30 patients). It was used in combination with a second flap as double PAP (21 patients) or combined with a DIEP (62 patients). Mean flap size was 403 g (range: 190-800 g) and mean patient body mass index was 26.5 (range: 18-43). Complications included total flap loss (3%), donor site cellulitis (4.9%), and significant donor site wound (6.8%). Currently, the PAP flap accounts for 16.9% of our autologous breast reconstruction and the DIEP flap accounts for 76.0%. Lower Extremity Functional Scale score was 75/80 (94%) by 6 months. Satisfaction with breast reconstruction was 78.9% and satisfaction with the thigh was 82.1%. Conclusions: The PAP flap is an excellent option for autologous breast reconstruction. Success rate and complications are similar to those of other options. There is no significant loss to lower extremity function and satisfaction with the reconstruction is comparable with other options.