BREAST RECONSTRUCTION WITH PAP

Name: Quel chirurgien pour une reconstruction par PAP à Paris ?
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The PAP is a flap used mainly for breast reconstruction in slender patients. This technique involves harvesting tissue from the thigh to reconstruct the breast.

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WHO SHOULD USE PAP

PAP is a recent technique for microsurgical reconstruction using a free flap harvested from the root of the thigh.

It is recommended for patients who wish to

reconstruction using their own tissue, i.e. they do not want breast reconstruction using implants (see breast reconstruction with implants)
but who would be too thin, for example, for a DIEP to be taken from the abdomen. (see breast reconstruction with DIEP)
have a relative contraindication to reconstruction with prostheses: radiotherapy, chemotherapy, lack of skin.
do not wish to undergo dorsalis major flap reconstruction.

PAP RECONSTRUCTION

The surgical technique

The PAP is a free flap harvested from the root of the thigh, at groin level and just below the buttock.

The tissues harvested are skin, fatty tissue and vessels, enabling a graft to be placed on the skin. breast reconstruction.

This flap is called PAP for "Profunda Artery Perforator", which is the artery on which the irrigation of this flap depends.

The surgeon prescribes a CT scan of the vessels in the thigh to ensure that the surgery is feasible.

The plastic surgeon The flap is removed using microsurgical magnifying glasses, a very fine surgical technique.

Once the flap has been isolated, it is connected to the internal mammary vessels at the level of the breast reconstruction.

Removal of the flap leaves a scar at the root of the thigh (at groin level).

THE AFTERMATH OF THE PAP

Once the surgery is complete, the PAP flap must be monitored regularly by a specialized team to ensure its viability. After all, it's a transplant.

The patient usually stays in hospital for around 5 days, in the absence of intercurrent events.

Complete healing is usually achieved within 3 weeks.

Symmetrization surgery on the other breast can be scheduled from 3 months after PAP surgery.

Your Questions

Frequently Asked Questions in Consultation

DIEP OR PAP RECONSTRUCTION?

The choice between the two techniques is above all a matter of morphology.

DIEP is preferred in patients who

with a small stomach bulge, or abdominal apron
a large breast to rebuild

A PAP is preferred for patients

thin or slender, with no belly bulge
with a small breast to reconstruct
or with a contraindication to DIEP: previous tummy tuck, tummy liposuction

IS THIS SURGERY RISKY?

No,

The most serious complication would be reconstruction failure when the vessels connected to the breast become blocked.

This happens when the mammary vessels in the breast are severely damaged by radiotherapy or aggressive chemotherapy.

Unfortunately, we can't know in advance.

Reconstruction failure with a trained team does not exceed 2%.

PAP or prosthesis?

Several scientific studies have shown that the quality of life after autologous reconstruction (DIEP, PAP, etc.) is superior to the quality of life of patients 10 years after the procedure. reconstructed with implants.

It's easy to understand: autologous reconstructions are definitive reconstruction techniques using your own tissues. There are no late complications at a distance, unlike with breast implants.

Dr. Jérémy Djian

Dr. Jérémy Djian is a plastic surgeon based at 5 Square Thiers, near the Victor Hugo roundabout in Paris's 16th arrondissement.
He trained in Paris and remains affiliated with the hospital in the prestigious department headed by Prof. Laurent Lantieri.

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BREAST RECONSTRUCTION WITH PAP

WHO SHOULD USE PAP