Patient-reported and surgical outcomes of profunda artery perforator (PAP) flap breast reconstructions compared to deep inferior epigastric perforator (DIEP) using BREAST-Q

Abstract

BackgroundAutologous breast reconstruction patients require thorough assessment, with the profunda femoris artery perforator flap (PAP) having become an important autologous reconstruction option alongside the deep inferior epigastric perforator flap (DIEP). Breast reconstruction impacts patients psychologically, physically and mentally. The BREAST-Q aids to assess patient reported outcomes measures (PROMs). We aim to critically compare post-operative clinical outcomes, aesthetic results, morbidity and patient satisfaction between DIEP and PAP patients, using clinical follow-up and PROMs. MethodsA non-blinded two-armed prospective cohort study was performed. Patients undergoing PAP or DIEP reconstructions between January 2021 and February 2022 were included and followed up for at least one year post-operatively. Demographic and per-operative data was acquired. Breast-Q data was collected pre-operatively, and at 2-week, 3-month and 1-year intervals post-operatively. Results157 patients had autologous breast reconstruction (207 flaps), with 129 (82.1%) DIEP patients and 21 (13.3%) PAP patients. 37 (28.6%) patients underwent bilateral DIEP reconstructions and 1 (5%) PAP case was bilateral. Remaining PAP cases were stacked flaps for unilateral breast reconstruction. Mean ischaemia time for PAP was 55.29 (+/- 15.59minutes) compared to 69.52 (+/- 21.74minutes) for DIEP (p=0.014). Donor site wound dehiscence was significantly higher with PAP reconstructions (p=0.014). ConclusionsAt one year follow-up, no significant differences in PROMs across all domains between DIEP and PAP flap reconstructions were noted. This reflects that PAP flaps, despite having a more challenging donor site and higher donor site complications, provide an excellent reconstructive option with similar patient-reported outcomes when compared to the gold-standard DIEP flap reconstruction.