Breast reconstruction with the extended profunda artery perforator flap

BACKGROUND: The profunda artery perforator (PAP) flap is a reliable flap for breast reconstruction. By extending the traditional flap, it is possible to include more tissue and thereby enhance flap volume. The aim of this study is to demonstrate the technique for extended profundal artery perforator flap harvest and to demonstrate results in a population otherwise not suited for autologous breast reconstruction. METHODS: Retrospective chart review of all patients who received extended PAP flap breast reconstruction between 2016 and 2018 was performed. Patient demographics, perioperative data, and postoperative complications were recorded in a pre-defined form and analyzed. A fully illustrated and step-by-step description of the procedure was created and included. RESULTS: A total of 46 extended PAP flaps for breast reconstruction were performed on 28 patients. Forty-three were 'regular' extended PAP flaps, one was a stacked flap, and two were transverse myocutaneous gracilis flaps with extended PAP flap skin design. Mean pre-operative breast volume was 330 cc, and mean flap weight was 400 g. The success rate was high (97.8%), and complications included one partial flap loss (2.2%), one wound dehiscence of the breast (2.2%), and wound dehiscence of the donor site (11 patients, 23.9%). CONCLUSIONS: The modified and extended profunda artery perforator flap is an excellent autologous tissue option for breast reconstruction even in large-breasted patients or patients with a relatively low body mass index. Advantages include higher flap volume, reliable blood supply, higher skin volume, and the possibility of choosing from several perforators, making dissection more convenient