Breast reconstruction is a crucial step for many women following a mastectomy. Among the most popular choices are the PAP flap (Profunda Artery Perforator) and the DIEP flap (Deep Inferior Epigastric Perforator). Both techniques use your tissue, but they differ in the source and approach. Deciding which option is right for you depends on several factors, including your body type, health status, and personal preferences. At New York Group for Plastic Surgery, our surgeons can help you navigate these choices to find the best fit for your needs.
The sources of tissue used
The PAP flap uses tissue from the upper thigh, specifically the posterior thigh. This is ideal for patients who have insufficient abdominal tissue or prefer not to use their abdominal tissue. The DIEP flap uses tissue from the lower abdomen, including skin and fat, while preserving the abdominal muscles. This method is often chosen for its ability to recreate a natural-looking breast and because many patients have enough abdominal tissue available for reconstruction.
The impact on donor sites
The PAP flap procedure leaves a scar along the crease of your upper thigh, which can be easily concealed by underwear or swimwear. Some patients find this preferable as it avoids any impact on the abdominal area. Conversely, the DIEP flap results in a scar along the lower abdomen, similar to a tummy tuck. For many, this is an acceptable trade-off, especially since the abdominal area is often used for excess skin and fat removal, providing a dual benefit.
Recovery times and processes
The PAP flap involves a shorter recovery period, partly because it avoids the abdominal muscles, reducing post-operative pain and complications. Most patients can resume normal activities within a few weeks. The DIEP flap surgery, although muscle-sparing, involves a more extensive procedure due to the abdominal incision and may require a longer recovery period. Patients often need more time to regain full strength and resume strenuous activities.
Suitability for your body type
If you have ample tissue in your lower abdomen, the DIEP flap might be a better choice as it allows for a larger volume of tissue transfer, ideal for recreating larger breasts. If you have less abdominal tissue or prefer not to use it, the PAP flap is a suitable alternative, especially if you have more excess tissue in your thighs. Our surgeons will evaluate your body type and discuss the best options based on your unique anatomy and goals.
Risk of complications
The PAP flap procedure tends to have fewer complications related to the donor site since it avoids the abdominal area. Yet, it may involve more complex microsurgery due to the intricate blood vessels in the thigh. The DIEP flap, while generally safe, carries risks such as abdominal weakness or hernia, given the surgery’s location. Your surgeon will discuss these risks in detail and help you weigh them against the benefits to make an informed decision.
Aesthetic outcomes
The DIEP flap often provides a more natural breast appearance and feel, largely due to the quality and volume of abdominal tissue. Additionally, the abdominal scar can be strategically placed and might even provide a tummy tuck effect. The PAP flap can also produce excellent aesthetic results, especially for those who do not require a large volume of tissue. However, the outcome might vary based on individual body composition.
Long-term benefits and follow-up care
The DIEP flap offers robust long-term results with minimal need for additional surgeries once the reconstruction is complete. The abdominal area also heals well over time, contributing to a stable and durable reconstruction. The PAP flap might require more diligent follow-up due to the complexity of thigh tissue and blood vessels. Regular monitoring and care are essential to ensure lasting results and to address any possible complications promptly.
Making an informed decision
Ultimately, the decision between PAP flap and DIEP flap reconstruction should be made with the guidance of an experienced plastic surgeon. At New York Group for Plastic Surgery, our team of board-certified surgeons specializes in breast reconstruction and has extensive experience with both PAP and DIEP flap techniques. We understand that every patient is unique, and we are committed to providing personalized care tailored to your specific needs and goals.
During your consultation, we will thoroughly assess your medical history, body type, and personal preferences to recommend the best reconstruction option for you. By partnering with our surgeons, you can achieve a natural-looking, durable breast reconstruction. Please schedule a consultation to explore your post-mastectomy breast reconstruction options.
