174. Autologous Breast Reconstruction With Simultaneous Bilateral Lumbar Artery Perforator Flaps Improves Waistline Definition

Abstract

PURPOSE: The lumbar artery perforator (LAP) flap is a valuable secondary option for autologous breast reconstruction when traditional abdominal donor sites are not available. Sociodemographic morphometric analyses have shown that the ideal waistline is characterized by a waist-to-hip ratio (WHR) of 0.7. How the LAP donor site affects truncal proportions and whether LAP flaps may lead to potential secondary benefits concerning waistline definition has never been systematically investigated. METHODS: A retrospective review of 50 patients who underwent bilateral breast reconstruction with lumbar artery perforator flaps (100 flaps) from 2018 - 2022 was performed. Patient characteristics and postoperative complications were recorded. Pre- and postoperative standardized patient photographs were analyzed to identify postoperative changes in WHR to assess waistline definition. The patients’ individual perception of postoperative aesthetic changes to their waistline was determined by an electronic survey. RESULTS: The patients had a mean age of 51 (24 - 63 years) and a mean BMI of 26.9 kg/m2 (19.3 - 37.4 kg/m2). Postoperative donor site complications included seromas (n = 10), wound dehiscence requiring operative revision (n = 5), hematomas (n = 4), and wound infections requiring oral antibiotic therapy (n = 2). Flap loss rate was 2%. After reconstruction, patients were found to have an improved waistline definition, indicated by a significantly decreased WHR (0.85 vs. 0.80, P = 0.005). Patient reported outcomes were obtained from 53% of patients. Among those, 81% of patients felt that their waistline had aesthetically improved after reconstruction, 14% reported no changes to their waistline aesthetics, and only 5% reported that their waistline had aesthetically worsened. CONCLUSION: Bilateral LAP flap breast reconstruction leads to improved waistline definition bringing patients closer to ideal aesthetic proportions. This reconstructive approach is ideal for patients that are not candidates for abdominal free flaps, however, demonstrate excess flank tissue and seek a more defined waistline.