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.
Keywords
lumbar artery perforator flap - autologous breast reconstruction - donor site
