Donor Site Morbidity after Lumbar Artery Perforator Flap Breast Reconstruction

Abstract

Background The lumbar artery perforator flap is a second-choice flap in autologous breast reconstruction whenever a deep inferior epigastric artery perforator (DIEP) flap is not possible. Ideal candidates are pear-shaped women who do not have enough bulk on the abdomen or thighs. Patient-reported “satisfaction with breasts” is excellent but we were curious about the donor site morbidity. Methods We performed a retrospective study of all lumbar flap breast reconstructions performed between 2010 and 2019. Patients were invited by e-mail and telephone to take part in a BREAST-Q survey. Results One hundred fifty-four flaps were performed in 110 patients. Sixty-three patients filled out the BREAST-Q questionnaire. The most frequently observed donor site complications are seroma (35.1%), dehiscence (8.4%), and hematoma (3.2%). Correction of the donor site scar was performed in 31.8% of patients, lipofilling of the donor flank in 5.2%, and liposuction of the contralateral flank in 18.3% of patients. Body mass index (BMI) was the only significant risk factor for donor site complications. Patient-reported “satisfaction with donor site appearance” was good but significantly lower for primary reconstructions compared with secondary and tertiary procedures. Flap weight significantly influences patient-reported “physical wellbeing of the donor site.” Ninety-seven percent of patients would recommend the surgery to someone in a similar position and would do it all over. Conclusion The lumbar artery perforator flap is a good alternative for breast reconstruction in selected patients. The donor site issues consist mainly of seromas, prolonged discomfort, and a scar that might be noticeable to others, but patient-reported satisfaction is very high.

Bilateral Simultaneous LAP Flaps in Breast Reconstruction: Perioperative anesthetic outcomes addressing safety and feasibility

“…Overall, major complication rates and operative time of simultaneous bilateral LAP flaps are significantly higher than in simultaneous bilateral DIEP flaps; however, they are comparable to previously reported staged bilateral and unilateral LAP flaps. 32,33 In addition to this study, our current LAP flap success rates approach those of DIEP flaps. We believe that LAP flaps can be performed safely as a bilateral simultaneous operation.…”

Building Complex Autologous Breast Reconstruction Program: A Preliminary Experience

“…Despite the increased number of donor sites in patients undergoing complex autologous breast reconstruction, the rate of donor-site complications was similar between DIEP and complex flaps except for the rate of seroma in LAP patients (one out of five donor sites). Studies have shown that the rate of seroma was higher than in traditional donor sites, and we have begun to perform more aggressive donor site closure and use of compression to decrease the rate of seroma [31]. Interestingly, our length of stay in complex flaps stayed similar to patients undergoing DIEP flaps except for the four-flap patients.…”

“…It is predicted that flaps as large as 21 × 12 cm may be harvested with flap weights reported as high as 750 g [30]. The location of the scar for a LAP flap is able to be hidden below the waistline and found to be satisfactory to patients [31]. However, the use of this flap is limited to experienced microsurgeons for several reasons.…”

The versatile thoracodorsal artery perforator flap for extremity reconstruction: from simple to five types of advanced applications and clinical outcomes

“…Complex defects of the extremities frequently arise in clinical settings and are generally caused by trauma, lesion resection, and congenital abnormalities [ 1 – 4 ]. With the development of the perforator flap, reconstructive surgeons pursue not only flap survival but also improved appearance of the recipient site and reduced damage to the donor site [ 5 – 7 ]. Regarding different wounds, featureless flap transplantation is no longer performed.…”