FLAP.jpegBreast reconstruction is a common consideration for women who have undergone a mastectomy. Approximately 50% of breast cancer patients choose this surgery to restore the appearance and feel of their breasts. One prominent method used for breast reconstruction is the PAP (Profunda Artery Perforator) flap procedure, which utilizes tissue from the posterior thigh to create a new breast mound. 

Despite its prevalence, a recent national survey indicates that many women may not have received adequate information to fully evaluate the physical, financial, and emotional impacts of such procedures. Understanding the nuances of PAP flap breast reconstruction is essential for patients to make informed decisions. 

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At the Center for Microsurgical Breast Reconstruction, led by Dr. Hugo St. Hilaire, patients receive comprehensive care and support throughout the recovery process.

What is PAP Flap Breast Reconstruction?

PAP flap breast reconstruction is a surgical procedure that rebuilds the breast mound after a mastectomy using the patient's own tissue, also called “autologous tissue.” 'PAP' stands for Profunda Artery Perforator, highlighting the blood vessels that supply the tissue for this flap reconstruction. The skin and fat tissue is taken from the posterior thigh, specifically the upper inner thigh area, providing ample skin and fat without sacrificing any muscle.

The primary purpose of PAP flap breast reconstruction is to create a natural-looking and feeling breast mound using autologous tissue. One notable advantage of the PAP flap is that it leaves the muscles intact, leading to quicker recovery and reduced postoperative pain. This technique is particularly beneficial for patients who may lack sufficient abdominal tissue for other types of multiple flaps, such as the DIEP flap.  This method also avoids the use of implants, reducing the risk of implant-related complications and promoting a more natural appearance and texture.

How Will PAP Flap Surgery Impact the Appearance of My Breasts?

PAP flap surgery can improve the appearance of your breasts by using your medial thigh skin, specifically from the posterior thigh region. The medial thigh skin is an excellent donor site because it offers sufficient tissue without compromising muscle integrity. This technique enhances the shape, volume, and overall aesthetics of your breasts. By utilizing autologous tissue, PAP flap surgery ensures a natural look and feel, as the new breast mound is created from your own skin and fat, mimicking the texture of a natural breast. 

Patients often notice an overall improvement in breast contour and fullness following the procedure. The autologous breast reconstruction technique might also result in less scarring compared to other methods, as the incisions on the thigh are strategically placed to be less visible. Furthermore, another cosmetic benefit is the “thigh lift” effect, which many find enhances the contour of their thighs, as well.

It is essential to consult with a qualified surgeon like Dr. Hugo St. Hilaire to discuss your specific goals and expectations. Dr. St. Hilaire can provide personalized information and address any concerns you may have regarding the specific outcomes of the surgery to ensure that the chosen reconstruction method aligns with your desired results.

What Happens During PAP Flap Breast Reconstruction Procedures?

Initial Consultation

The procedure begins with a thorough consultation where the surgeon will discuss the patient’s medical history, evaluate the donor site on the inner thigh, and develop a custom surgical plan tailored to the patient's unique needs and expectations.

Pre-Surgery Preparation

On the day of the surgery, the patient is placed under general anesthesia. This ensures that the patient is comfortable and pain-free during the entire procedure.

The Surgery

The surgeon removes the necessary tissue from the upper inner thigh, including skin, fat, and blood vessels, while carefully preserving muscle integrity. This step is crucial for ensuring that the donor site remains functional and aesthetically pleasing.

Then, the tissue is transferred to the chest area. Here, the surgeon meticulously connects the blood vessels to the recipient site in the breast using microsurgical techniques. This intricate process ensures that the transferred tissue receives adequate blood supply, which is essential for its survival and integration.

Advanced Stacked Flap PAP Breast Reconstruction

In addition to the standard PAP flap procedure, our center offers the advanced stacked flapPAP breast reconstruction. This innovative approach utilizes two flaps of tissue from the inner thighs and is most commonly used when a patient doesn’t have enough fatty tissue for reconstruction with a single flap. This technique is particularly beneficial for patients needing a larger volume reconstruction. The stacked flap technique maximizes aesthetic outcomes while minimizing donor site morbidity, often resulting in minimal scarring and an enhanced contour in both the breast and thigh areas.


Throughout the recovery process, our team, led by Dr. Hugo St. Hilaire, provides comprehensive care and guidance to ensure optimal healing and patient satisfaction. Regular follow-up appointments are scheduled to monitor progress and address any concerns, ensuring that each patient achieves their desired aesthetic and functional outcomes.

One of the standout benefits of PAP flap breast reconstruction, including the stacked flap variant, is the relatively shorter recovery time. Patients can typically expect to return to their normal activities more quickly compared to other reconstruction methods. The utilization of autologous tissue also eliminates the risk of complications associated with implants.

Benefits of PAP Flap Over Other Reconstruction Options

When considering breast reconstruction options, it's essential to understand the comparative benefits of each method to make an informed decision. PAP flap breast reconstruction offers distinct advantages over methods like DIEP flap and implant-based reconstruction.

PAP Flap vs. DIEP Flap

Both PAP (Profunda Artery Perforator) flap and DIEP (Deep Inferior Epigastric Perforator) flap are autologous tissue reconstruction procedures, meaning they use the patient's own tissue to create a breast mound. Here are some key comparisons:

  • Donor Site: The PAP flap uses tissue from the upper inner thigh, whereas the DIEP flap harvests tissue from the abdominal area. For patients who have had previous abdominal surgeries or lack sufficient abdominal tissue, the PAP flap can be a preferable option. Unlike other flaps, the scar of the PAP flap can often be well hidden in the crease of the thigh and lower buttock.
  • Muscle Preservation: Like all other flap procedures performed at the Center for Microsurgical Breast Reconstruction, the PAP flap transfers only the skin and fat, thereby leaving the muscle in place to preserve function. Both techniques aim to preserve muscle integrity; however, a TRAM flap, the DIEP’s predecessor, does focus on using tissues from the abdominal muscles, which can potentially lead to issues like hernias or muscle weakness.
  • Scarring and Contours: PAP flap surgery often results in less noticeable scarring since the incisions on the thighs are more discreet. The elliptical design of the PAP flap provides an ideal shape to create a natural breast. DIEP flap, on the other hand, may leave more noticeable abdominal scars.
  • Additional Advantages: Other advantages of the PAP flap include its rigorous and lengthy blood vessels, which allow for versatility in choosing reattachment vessels at the mastectomy site. Because the dissection avoids the inguinal lymphatics, there is a great reduction in the risk of lymphedema and seromas. Due to all these benefits, the PAP flap has rapidly become the go-to option for those without enough abdominal tissue for a DIEP flap.

PAP Flap vs Implant-based reconstruction

Implant-based reconstruction involves inserting silicone or saline implants to recreate the breast shape. Comparing PAP flap with implant-based reconstruction highlights several benefits:

  • Natural Look and Feel: PAP flap reconstruction uses the patient's own fatty tissue, resulting in a breast that feels and looks more natural compared to implants, which can sometimes appear or feel artificial.
  • Longevity: Autologous tissue flaps like PAP are permanent, whereas implants might require future replacement or revision surgeries due to issues like rupture, shifting, or capsular contracture (scar tissue forming around the implant).
  • Lower Risk of Complications: Using the patient’s tissue reduces the risk of complications associated with implants, such as infection, implant rejection, or allergic reactions. Additionally, there is no risk of implant rupture or leakage.

While each reconstruction method has its own set of benefits and potential drawbacks, PAP flap breast reconstruction stands out for its ability to provide natural-looking results with a focused approach on muscle preservation and minimized scarring. Consulting a qualified surgeon like Dr. Hugo St. Hilaire can help determine which option is best suited to meet a patient's unique goals and circumstances.

Am I A Good Candidate for PAP Flap Breast Reconstruction?

Determining whether you are a suitable candidate for PAP flap breast reconstruction depends on various factors such as your body type, health status, and prior surgical history. Ideal candidates are generally those who have the following:

  • Insufficient abdominal tissue for a DIEP flap
  • Sufficient tissue in the upper inner thigh area
  • Good overall health
  • A desire for a more natural look and feel
  • Preference to avoid potential complications associated with implants

To discover if you are a candidate for PAP flap breast reconstruction, we encourage you tofill out our interest form. By contacting us, we will provide a secure link to a comprehensive application that you can complete securely and at your own convenience from the comfort of your home.

Once you submit the application, one of our skilled surgeons will carefully review your details and recommend the best options tailored to your needs. We are committed to treating your privacy with the utmost care, ensuring your information remains confidential. Take the first step toward a confident and informed decision by contacting us today.

Take the Next Step Towards Natural Breast Reconstruction

Discover the benefits of PAP flap breast reconstruction by booking an appointment at the Center for Microsurgical Breast Reconstruction with Dr. Hugo St. Hilaire. Enjoy natural-looking results, minimized scarring, and long-lasting outcomes. Take control of your breast reconstruction journey today—schedule your consultation to explore your options with Dr. St. Hilaire. Your path to recovery and renewed confidence starts here.

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