Bilateral free profunda artery perforator flaps(PAP) for immediate unilateral breast reconstruction: a case report and review of literature

Abstract

Objective To investigate the possibility of using the profunda artery perforator flap (PAP) for breast reconstruction cases who are not the good candidates for back and abdominal donor sites. Methods This case was a breast cancer patient who required an i mmediate breast reconstruction with autologous tissue,skinny, bilateral severe breast atrophy and mastoptosis after lactation, twice cesarean delivery and umbilical hernia in August, 2016. Portable Doppler was used to detect the profunda artery perforator. The donor sites were designed according to the tissue defect after the mastectomy. The incisions were designed near to the inferior gluteal folds and medial gluteal areas. The left PAP flap was 20 cm × 5 cm, and the right PAP flap was 18 cm × 5 cm. The pedicles length of the both flaps were about 6.0 cm, and the perforator artery diameter of the both flaps were 2.2 mm. The right PAP vessels were connected to the left thoracodorsal vessels with end-to-end anastomosis. The left PAP vessels were connected to the proximal part of left internal ma mmary vessels with end-to-end anastomosis. The indocyanine green angiography under microscope showed the signs of patency in all the vessel anastomosis. Results The intraoperative patho-logic diagnosis was extensive intraductal carcinoma, and the sentinel lymph nodes biopsy showed negative result. The re-constructive breast has a nice appearance, natural and proper IMF. Both of the PAP flaps survive 100%, and the donor sites healed well and remained inconspicuous. The patient can walk freely on the 5th day postoperative, and back to home on the 7th day. Within the follow-up for one month, the patient was very satisfied with the new breast and a better gluteal appearance. Conclusion The free PAP flaps provide an excellent alternative to an abdominal and back donor sites for achieving the breast reconstruction due to the relaible supplying pedicle vessels and invisible donor scars. Key words: Profunda artery perforator (PAP); Breast reconstruction; Autologous tissue; Perforator flap