Bilateral LAP Flaps for Breast Reconstruction: A Perforator Classification System.

Abstract

Autologous breast reconstruction is continually evolving with focus on the ideal donor site. This study presents 108 consecutive simultaneous LAP flaps and a perforator classification system. An IRB approved retrospective review of all LAP flaps was completed and appropriate data recorded. All simultaneous bilateral LAP flaps were included, and perforator patterns were assessed using CTA. Fifty-four patients (108 flaps) were included in the final review. Mean age was 50.7 and mean BMI was 26.6. Mean ischemia times for all flaps and grafts were 130 +/- 64.5 and 300.6 +/- 97.3 minutes, respectively. Pedicle lengths averaged 4.6 +/- 1.5 cm and composite graft lengths averaged 6.2 +/- 1.7 cm. Donor site complications consisted of seromas (10 patients, 19%), hematomas (six patients, 11%), procedural wounds (four patients, 8% ), and infections (two patients, 4%). Total flap loss rate was 2.8%. Perforators were classified into categories based on pedicle pattern, lumbar spine level, and clusters, all in relation to posterior iliac bone as seen per CTA. Vascular pedicle patterns were categorized as type one (43.9%), two (45.6%), three (8.8%), and four (1.8%). Perforators were dissected at lumbar spine level L3 in 51.8% of patients, L4 in 46.5%, and L5 in 1.8%. We present a CTA directed, anatomical perforator classification system to assist in pre-operative planning, guide in dissection and choosing composite graft suited best for particular perforator pattern or calibers. Simultaneous LAP flaps can be successfully performed with excellent outcomes in patients unsuitable for other flaps.