BREAST RECONSTRUCTION WITH PAP
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.
- The PAP flap breast reconstruction uses thigh tissues (skin, fat, vessels) to recreate a breast without an implant.
- It is indicated for slim patients not eligible for a DIEP or with a contraindication to prostheses (radiotherapy, lack of skin).
- The flap is removed at the level of the thigh root, then reconnected to the vessels of the thorax by microsurgery.
- The procedure lasts approximately 4 to 5 hours, with 5-day hospital stay and 3 weeks healing.
- It enables natural, sustainable reconstruction, with a discreet scar hidden in the groin crease.
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 thigh vessels 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 in the breast to be reconstructed.
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 is a plastic surgeon based at 5 square Thiers, near the Victor Hugo roundabout, in the 16th arrondissement of Paris.
He trained in Paris and remains attached to the hospital in the prestigious department of Pr Laurent Lantieri.
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