“Comparison of DIEP and PAP free flaps for breast reconstruction in the context of breast cancer: A retrospective study of 677 patients over 10 years”

Abstract

BackgroundPAP (Profunda Artery Perforator) flap following cancer surgery has emerged as a relevant alternative for breast reconstruction but remains mainly used in cases where the DIEP (Deep Inferior Epigastric Perforator) flap cannot be performed. The aim of this work is to compare PAP and DIEP flaps’ surgical and aesthetics outcomes in breast reconstruction. MethodsWomen who underwent breast reconstruction by DIEP or PAP flap at the Plastic Surgery Department of Georges Pompidou European University Hospital, Paris, France, between January 2012 and December 2020 were included. Patient’s demographic characteristics were recorded as well as type, laterality and timing of reconstruction. Operative times, length of hospital stay, general and surgical complications were compared. The number of late surgical reoperations, their timing relative to the initial reconstructive procedure, and their purpose were also compared. ResultsA total of 677 patients were included, 559 of whom received a DIEP flap and 118 a PAP flap. PAP flap patients were significantly younger, thinner, and had a smaller initial bra cup size than those who received a DIEP (p<0.001) Operative time was similar for both groups (p=0.074). There was no difference in the number of early postoperative reoperations (p>0.554) or of late revisions (p>0.403) between DIEP or PAP. ConclusionProvided that the technical and human resources are available, PAP flap is a valid technique, with no increased risk of surgical complications and reoperations, nor lengthening of operative time. The PAP flap should be considered a primary therapeutic option and not only an alternative to the DIEP flap.