Developed in 2010, the PAP flap is Dr. Allen’s most recent addition to the perforator flap family. The PAP is an excellent donor site option for women who have had previous abdominal surgery or have limited abdominal tissue.
The PAP flap is based on the profunda artery perforator and utilizes the tissue of the posterior thigh. Unlike other flaps, the scar of the PAP flap can often be well hidden in the crease of the thigh and lower buttock.
Other advantages of the PAP flap are its rigorous and lengthy blood vessels that allow for versatility in choosing reattachment vessels at the mastectomy site, its elliptical design that provides an ideal shape for coning to create a natural breast, and because the dissection avoids the inguinal lymphatics, there is a great reduction in the risk of lymphedema and seromas, as well. And, like all other perforator flaps, the PAP flap transfers only the skin and fat, thereby leaving the muscle in place to preserve function. Because of all its benefits, the PAP flap has rapidly become the go-to option following a DIEP flap.