If you’ve had a mastectomy to treat your breast cancer or for preventive measures, we know it can be difficult to reclaim your confidence. However, our experts offer the PAP flap procedure, designed to offer reconstruction in the least invasive way possible, providing more natural results.
Read on to hear what our experts, James Mayo, MD, and Lindsey Duncan, PA-C, say about PAP flap procedures, including how they’re performed and how they can benefit you.
PAP Flap 101
A PAP flap procedure aims to reconstruct a natural-looking breast for patients using their own tissue, also called autologous tissue. Lindsey Duncan explains, “In terms of breast reconstruction, the PAP flap procedure is where skin and fat from the inner thigh is used to recreate breasts for patients who have undergone complete or partial mastectomy.”
The acronym PAP stands for profunda artery perforator, the blood vessels providing tissue in your upper thigh. Your surgeon makes an incision in your thigh, removing skin, fat and blood vessels. They then reattach the blood vessels from the flap to the blood vessels in your chest through microsurgery, giving you a new breast with extra skin and fat while preserving the muscles in your thigh.
Benefits of PAP Flap Procedures
PAP flap procedures offer numerous benefits. Dr. Mayo tells us, “One of the benefits is that this procedure uses a patient’s own tissue to recreate the breast. It’s an ideal solution for people who want reconstruction surgery but can’t have implants placed or would prefer a more natural result.”
The “gold standard” of autologous breast reconstruction surgery, known as the deep inferior epigastric perforator (DIEP) procedure, uses extra tissue from the abdomen rather than the thigh. However, DIEP makes it harder for those with previous abdominal surgeries to go this route, causing them to look for an alternative option. Since the PAP flap procedure uses tissue from the thigh, it’s much more accommodating for these patients.
One of the most unique benefits of a PAP flap procedure is its ability to preserve muscle. Similar procedures like the TRAM flap make incisions in the abdominal muscles, leading to potential issues like hernias and muscle weakness.
Compared to other traditional procedures, other benefits of the PAP flap procedure include:
- Less noticeable scarring
- Longevity of breast tissue
- Lower risk of complications
- Lower risk of infection
- Natural look and feel
There are also medical benefits to this procedure. “Patients can have reconstructive surgery without needing implants, which require replacement and additional surgeries down the line. There’s also decreased risk of infection compared to implant-based reconstruction as no foreign object is placed,” says Dr. Mayo. Although this procedure has significant benefits, you may wonder if it’s right for you.
Is a PAP Flap Procedure Right for Me, and Are Patients Typically Satisfied?
This procedure is great for those who are unable to have the DIEP procedure. Another mark of being a good candidate is having ample inner thigh tissue. “Ideal patients are non-smokers with a BMI under 38 who are non-diabetic, have well-controlled diabetes and don’t have a history of significant heart disease,” says Lindsey.
This procedure usually holds high levels of patient satisfaction. Lindsey tells us, “Patients who have this procedure are typically highly satisfied since they can have breast reconstruction using excess tissue.”
Would a PAP Flap Ever Be Medically Necessary?
Lindsey informs us, “This procedure may be medically necessary if patients have wounds from previous surgeries or severe damage from radiation. This allows us to remove damaged or unhealthy tissue and replace it with healthy tissue from a different part of the body.”
Recovering From a PAP Flap Procedure
Like any surgery, recovery is one of the most valuable parts of its success. “We recommend about six to eight weeks of recovery with patients on physical restrictions for around six weeks after the procedure,” says Dr. Mayo. “Adhering to physical restrictions, including avoidance of tension at the incision site, is vital to heal from the surgery.” It’s also a good idea to keep the incision site covered, keeping it dry and clean to allow for proper healing.
“We also recommend a high-protein diet. For those who have diabetes, it’s vital to keep your blood glucose controlled after the operation,” says Dr. Mayo.
Supplemental wound powder like Juven might be right for you if you're prone to developing wounds. Lindsey says, “Physical or occupational therapy is recommended after surgery to help patients with their range of motion, mobilization and scar tissue problems they may face post-operatively.”
Helping You Feel Whole After Cancer
At AdventHealth, we seek to care for all of you in body, mind and spirit. Visit us here to learn more about our plastic and reconstructive surgery services or request an appointment if you’re ready to take your next step. You deserve to feel confident in your body after healing from cancer.
