Profunda Artery Perforator (PAP) Flap for Breast Reconstruction

Perforator flap breast reconstruction has strong appeal for many women undergoing mastec‐ tomies, but the procedure requires adequate donor site tissue. The most common donor site for perforator flap breast reconstruction is the abdomen, such as the deep inferior epigastric perforator (DIEP) or superficial inferior epigastric artery (SIEA) flap, as most women have adequate donor site tissue, the procedure may be performed in the supine position, and the perforating vessels have a dependable caliber and length. In the past, the second line option was usually the buttock, but the buttock as a donor site had multiple disadvantages – most notably a short vascular pedicle, a deforming donor site defect, and a long operative time due to the need to reposition the patient for harvest and inset. Recently, the posterior thigh has emerged as an excellent donor site for perforator flap breast reconstruction. Indeed, the profunda artery perforator (PAP) flap, which uses the skin and fat of the posterior thigh, has surpassed the gluteal artery perforator (GAP) flap in our practice as the second line donor site for microsurgical breast reconstruction.