Alternative donor sites in autologous breast reconstruction: A clinical practice review of the PAP flap Review


Authors: Lu, J.; Zhang, K. K.; Graziano, F. D.; Nelson, J. A.; Allen, R. J. Jr
Review Title: Alternative donor sites in autologous breast reconstruction: A clinical practice review of the PAP flap
Abstract: Breast cancer is currently the most common cancer in female patients in the United States and around the world, with over 2 million new cases of breast cancer diagnosed in 2020. Subsequently, breast reconstruction after mastectomy is also becoming increasingly common. While not every patient elects to undergo reconstruction after mastectomy, many patients desire reconstruction with either implant-based or autologous tissue. In certain patients, autologous reconstruction can offer a multitude of advantages over implant-based reconstruction. While abdominally-based free flaps such as the deep inferior epigastric perforator (DIEP) flap have become the flap of choice for breast reconstruction, the profunda artery perforator (PAP) flap is a strong alternative for patients in which abdominally-based flaps are contraindicated or insufficient. This clinical practice review aims to summarizes the history of the PAP flap, describe relevant anatomy and characteristics of the PAP flap that make it a well-suited option in breast reconstruction. It will also provide clinical pearls related to pre-operative preparation, markings, and surgical technique involved in ensuring successful perforator dissection, flap harvest, inset, and survival. Finally, this review will discuss current literature published on PAP flaps to determine post-operative clinical outcomes, complications, and patient reported outcomes associated with PAP flap breast reconstruction. © Gland Surgery. All rights reserved.
Keywords: breast reconstruction; autologous breast reconstruction; profunda artery perforator flap (pap flap)
Journal Title: Gland Surgery
Volume: 12
Issue: 4
ISSN: 2227-684X
Publisher: AME Publishing Company  
Date Published: 2023-04-28
Start Page: 516
End Page: 526
Language: English
DOI: 10.21037/gs-22-603
PROVIDER: scopus
PMCID: PMC10186161
PUBMED: 37200935
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Robert J. Allen Jr -- Source: Scopus
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MSK Authors
  1. Jonas Allan Nelson
    212 Nelson
  2. Jocelyn Lu
    1 Lu
  3. Kevin Kaiwen Zhang
    10 Zhang