Abstract
Background The profunda artery perforator (PAP) flap has emerged as an excellent secondary option
for autologous breast reconstruction. Despite the increased acceptance, potential
secondary benefits concerning aesthetic proportions of proximal thigh and buttock
at the donor site have never been systematically investigated.
Methods A retrospective review of 151 patients who underwent breast reconstruction with horizontally
designed PAP flaps (292 flaps) from 2012 to 2020 was performed. Patient characteristics,
complications, and numbers of revision surgeries were collected. In bilateral reconstructions,
pre- and postoperative standardized patient photographs were analyzed to identify
postoperative changes in proximal thigh and buttock contour. The patients' own perception
of postoperative aesthetic changes was determined by an electronic survey.
Results The patients had a mean age of 51 and a mean body mass index of 26.3 kg/m2. The most common complications were minor and major wound complications affecting
35.1% of patients, followed by cellulitis (12.6%), seroma (7.9%), and hematoma (4.0%).
A total of 38 patients (25.2%) underwent revision of the donor site. After reconstruction,
patients were found to have aesthetically improved proximal thigh and buttock proportions,
indicated by a wider thigh gap (thigh gap-hip ratio: 0.05 ± 0.04 vs. 0.13 ± 0.05,
p < 0.0001) and reduction in lateral thigh-to-buttock ratio (0.85 ± 0.05 vs. 0.76 ± 0.05,
p < 0.0001). Among the 85 patients who responded to the survey (56.3% response rate),
70.6% felt that PAP surgery had aesthetically either improved their thigh contour
(54.12%) or not changed it (16.47%), whereas only 29.4% reported that the surgery
negatively impacted their thigh contour.
Conclusion PAP flap breast reconstruction leads to improved aesthetic proportions of the proximal
thigh and buttock. This approach is ideal for patients with ptotic tissue of the inferior
buttocks and medial thigh, a poorly defined infragluteal fold, and inadequate anterior-posterior
buttock projection.
Keywords
profunda artery perforator flap - thigh aesthetics - breast reconstruction
