Comparison of Lumbar Artery and Superior Gluteal Artery Perforator Flaps for Breast Reconstruction

Abstract

Background: Although the deep inferior epigastric artery perforator flap is the criterion standard for autologous breast reconstruction, lumbar artery perforator (LAP) and superior gluteal artery perforator (SGAP) flaps are recent trends as alternatives. The purpose of our study was to clarify differences of these flaps based on multislice CT findings of the same patient. Methods: Retrospective study was conducted on 58 patients who underwent preoperative contrast-enhanced multislice CT for breast reconstruction using deep inferior epigastric artery perforator. Of these, 32 patients' data were evaluated excluding 26 patients' data either for the lumbar or gluteal fat being outside the imaging range or for nondepiction of the vascular pedicle origin of LAP or SGAP flap. Vascular pedicle diameter, pedicle length, and subcutaneous fat thickness were measured for LAP and SGAP flaps. Results: The vascular pedicle diameter, pedicle length, and fat thickness were 2.1 (SD, 0.3) mm, 3.4 (SD, 0.4) cm, and 4.9 (SD, 1.0) cm, respectively, for LAP flaps; and 1.7 (SD, 0.2) mm, 5.6 (SD, 1.1) cm, and 2.7 (SD, 0.7) cm, respectively, for SGAP flaps. Conclusions: The LAP flaps had thicker subcutaneous fat and a larger vascular pedicle diameter, whereas the SGAP flaps had a longer vascular pedicle. As donor material for breast reconstruction, the LAP flap is indicated for cases where absolute volume is needed; otherwise, the SGAP flap is more advantageous as it facilitates vascular anastomosis with its longer vascular pedicle.

Autogenous breast reconstruction for total mastectomies: a narrative review

“…Those two flaps are not go-to flaps, but can constitute an option in case of unavailability of others. Indeed, they present many disadvantages: limited volume offered, an average-sized skin paddle (approximately 8 cm × 18 cm) ( 60 ), a short pedicle (5.6 cm) and a small diameter artery for IGAP (1.7 mm) ( 61 ), a loss of padding on thin patients, buttock asymmetry and contour deformity ( 62 ) and a low quality of tissue for a breast reconstruction because of the very firm texture. The SGAP flap presents a pedicle of a larger diameter (3.38 mm) and an average length of 9.1 cm ( 63 ).…”

Analysis of flap thickness to breast projection ratio correlating to body mass index and age in east Asian women: Considerations in flap selection in breast reconstruction

“…The main disadvantage of the LAP flap is the need for arterio–venous grafts; therefore, surgeons should accomplish a position change and perform another microsurgical anastomosis (Sultan & Greenspun, 2023). However, despite this disadvantage, recent published reports have included descriptions with surgical and anatomical details for the LAP flap, and many surgeons have used this flap as primary and secondary options for breast reconstruction (Hidaka et al, 2022; Peters et al, 2015; Stillaert et al, 2023; Vonu et al, 2022). We also agree that the LAP flap provides sufficient volume and thickness for breast reconstruction with consistent surgical outcomes.…”

“…Although the DIEP flap is available in most cases, in some instances however, the abdominal donor site is inadequate because of insufficient volume, prior surgical procedures, or failed abdominal flap reconstruction. Several alternative locations have been introduced in such cases, including gluteal‐based flap, thigh‐based flap, and lumbar artery perforator (LAP) flaps (Buchel et al, 2013; Guerra et al, 2004; Haddock & Teotia, 2020; Hidaka et al, 2022; Jo et al, 2022; Schoeller et al, 2008; Yaghoubian & Boyd, 2011).…”