Robert J. Allen M.D.

Reinventing the DIEP – the PAP Flap

September 26th, 2012 admin

The PAP flap is my most recent development, providing yet another donor site option for the reconstruction of your breasts. The PAP flap, or profunda artery perforator flap, makes use of the backside of the thigh, just below the buttock crease.  While the DIEP flap is generally considered first, in cases where the abdomen cannot be used, the PAP is an excellent secondary option.  And while the PAP may be secondary in donor site consideration, it is surely not secondary in reconstructive results or benefits.  In fact, there are various advantages to using the PAP flap for your reconstruction.

From a cosmetic standpoint, it is the only donor site that allows the scar to be well hidden – in this case, it is hidden in the crease of the thigh and lower buttock.  Further, the elliptical shape of the flap lends itself nicely to coning to recreate the natural shape of the breast.  Another benefit of the PAP flap is its lengthy blood vessels that allow for versatility in choosing reattachment vessels at the mastectomy site.  And, lastly, the dissection of the PAP flap avoids the abdomen and therefore the inguinal lymphatics, allowing for a great reduction in the risk of lymphedema and other fluid collection postoperatively.

Since its development in 2010, I have performed nearly 100 PAP flaps and the patients are simply raving.  Just as the DIEP flap was the first of its kind and has set the standard for breast reconstruction, the PAP flap has the potential to surpass the DIEP and set a whole new standard all its own.