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.

Natural Breasts, Even After Breast Cancer

February 10th, 2012 admin

23 years ago, my mother was diagnosed with breast cancer.  Faced with a possible mastectomy, she would require breast reconstruction in order to maintain her active lifestyle, including various water sports.  Put in charge of her reconstruction, I initially planned the traditional pedicle TRAM procedure, which would force her to sacrifice the complete function of her rectus abdominus muscle and therefore, her active lifestyle as well.  Fortunately for my mother, when re-excising the cancer, she was found to have clear margins, and did not require a mastectomy with reconstruction.  She instead underwent a lumpectomy with radiation.  However, it was this experience that challenged and inspired me to develop better, less quality of life sacrificing options for women and breast reconstruction.  After studying the blood supply to the skin and fat above the muscle in the lower abdomen, I discovered how to use a microsurgical technique to reliably transfer only the skin and fat from the abdomen to recreate the breast, while completely avoiding the use of abdominal muscle altogether.  This was called a perforator flap.  This discovery, called the deep inferior epigastric perforator or DIEP flap, was the first ever developed perforator flap for breast reconstruction, as well as the birth of the entire field of perforator flap breast reconstruction known today.


Unfortunately, not all women are as lucky as my mother.  Every year, thousands of women around the world must undergo the traumatic experience of mastectomies and reconstruction, the majority of which still undergoing traditional techniques that often sacrifice function or lead to painful persistent problems.   For that reason, I have dedicated my entire career to the development and continuous refinement of perforator flap breast reconstruction – the only form of breast reconstruction that I believe gives women the most optimal quality of life post mastectomy.  And therefore, I have chosen to write this blog in attempt to reach out, better inform and provide education about this truly wonderful form of breast reconstruction that I believe all women need to know about.