Comparative Study of DIEP and PAP Flaps in Breast Reconstruction: Reconstructive Outcomes and Fat Necrosis

Abstract

Background: This study compared the reconstructive outcomes and fat necrosis of the profunda artery perforator (PAP) flap with the deep inferior epigastric artery perforator (DIEP) flap. Methods: Data on all DIEP and PAP flap breast reconstructions performed between 2018 and 2021 at Asan Medical Center were compared. The overall reconstructive outcomes and presence of fat necrosis were analyzed through ultrasound evaluation performed by a board-certified radiologist. Results: The PAP (n=43) and DIEP flaps (n=99) were used to reconstruct 31 and 99 breasts, respectively. The average age of the patients in the PAP flap group (39.1 ± 7.3 years) was lower than the DIEP flap group (47.4 ± 7.7 years), and the body mass index of patients undergoing PAP flap reconstruction (22.7 ± 2.8 kg/m²) was lower than those undergoing DIEP flap reconstruction (24.3 ± 3.4 kg/m²). There was no total loss of both flaps. Donor site morbidity was higher in the PAP flap group (11.1%) compared with the DIEP flap (1.0%). The rate of fat necrosis was higher in the PAP flaps (40.7%) than in the DIEP flaps (17.8%) during ultrasound. Conclusions: In our study, PAP flap reconstruction tended to be performed in patients who were younger with lower BMIs compared with the DIEP flap. Successful reconstructive outcomes were observed in both the PAP and DIEP flaps; however, a higher rate of necrosis was observed in the PAP flap compared with the DIEP flap.

Reduction in Seroma Rate Following Deep Inferior Epigastric Perforator Flap with Umbilectomy Utilizing Progressive Tension Sutures

“…Finally, as additional donor sites continue to be used more frequently in patients who are not candidates for DIEP flaps, it will be important to study the potential benefit of PTS at other donor sites in the future. [29][30][31][32]…”

Aesthetic Implications of Bilateral Profunda Artery Perforator Flaps on Thigh and Buttock Proportions

“…The PAP flap is a safe and robust option for breast reconstruction in patients with insufficient tissue for abdominal free flaps. 3,4,6,16,17 PAP flap reconstruction has become particularly popular in younger patients and patients with a low BMI, and Enhanced Recovery After Surgery protocols have been established, which reduce inpatient opioid use and length of hospital stay. 16,18,19 Here, we demonstrate that PAP flap breast reconstruction leads to a favorable aesthetic outcome at the donor site, namely, an improvement of the Based on the authors' experience, several surgical considerations are key to achieving these results.…”

“…3,4,6,16,17 PAP flap reconstruction has become particularly popular in younger patients and patients with a low BMI, and Enhanced Recovery After Surgery protocols have been established, which reduce inpatient opioid use and length of hospital stay. 16,18,19 Here, we demonstrate that PAP flap breast reconstruction leads to a favorable aesthetic outcome at the donor site, namely, an improvement of the Based on the authors' experience, several surgical considerations are key to achieving these results. PAP flap dissection removes the entire superficial investing fascia of the proximal medial thigh.…”

Association between body mass index and outcomes after autologous breast reconstruction: a nationwide inpatient database study in Japan

“…43 The use of an abdominal ap may result in a longer operative time and lower donor-site morbidity than that of a thigh ap. 43,44 Second, the Diagnosis Procedure Combination database does not provide detailed operative information such as operative time. We Characteristic Total Body mass index (kg/m 2 ) P value <18.5…”