[Immediate autologous breast reconstruction by profund artery perforator flap at the expense of the profund femoral artery: Technique and results (IBR by PAP)].

Authors

M Hivelin

Published in

Annales de chirurgie plastique et esthetique. Volume 71. Issue 6. Pages 673-687.

Abstract

The profunda artery perforator (PAP) free flap, introduced for breast reconstruction by Allen in 2012, has become an increasingly important autologous option, particularly in immediate breast reconstruction (IBR).
The PAP flap relies on perforators from the profunda femoris artery, consistently present in 98.8% of cases, with a mean diameter of 1.9mm and a pedicle length of 10 to 12cm. The fasciocutaneous paddle is harvested from the posteromedial thigh, below the infragluteal fold, with the patient in the dorsal lithotomy position, an approach that enables a two-team setup with simultaneous flap harvest and mastectomy with preparation of the internal mammary vessels. Preoperative planning relies on CT angiography and Doppler ultrasound to select the optimal perforator based on caliber, location, and course. Microsurgical anastomoses are performed to the internal mammary vessels. Mean flap volume is approximately 325cm³, and secondary fat grafting is performed in nearly all cases to achieve the desired final volume.
Two patients illustrate the technical variants: the first (42 years old, recurrence following lumpectomy and radiotherapy) underwent flat flap inset to replace the resected skin; the second (46 years old, similar oncological context) had a cone-shaped flap modeled to allow immediate nipple-areola complex (NAC) reconstruction, with stable outcomes at 3years following fat grafting and areola dermopigmentation.
Recent meta-analyses report total failure rates of 2% and fat necrosis rates of 6.1%. Donor-site morbidity remains moderate, with wound dehiscence occurring in 10 to 21% of cases. With over 14 years of follow-up, the PAP flap represents the best autologous alternative to the DIEP flap in IBR, combining anatomical reliability, absence of functional muscle morbidity, and a well-concealed donor-site scar.

PMID:
43014850
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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