PAP SURGERY

OVERVIEW

When it comes to having a breast reconstruction, we want to provide you with many options, and when there is not enough tissue to perform an autologous tissue flap from the abdomen, our plastic and reconstructive surgeon, Dr. Torabi, may suggest a PAP (profunda artery perforator) flap surgery where the tissue is take from the inner thigh instead. This alternative to DIEP flap surgery will take the tissue and blood vessels from your thigh (at the crease of your buttocks), and leave the same scarring as a plastic surgery called a thigh lift. Blood vessels to the flap are preserved and reconnected at the mastectomy site. Unlike the TUG (transverse upper gracilis) flap, no muscle is sacrificed with a PAP Flap. The donor site scar is well hidden in the buttock crease. This type of reconstruction is performed when the patient has already had the abdominal fat taken for previous surgeries or reconstruction, or if there is just not enough fatty tissue on the abdomen to make a breast.

PAP surgery can be performed by Phoenix, AZ and Scottsdale, AZ reconstructive surgeon, Dr. Torabi immediately after a mastectomy, or it can wait for a later surgery date. At Elite Plastic Surgery, we can help you decide which surgery is best for you. With a personal consultation, our plastic and reconstructive surgeons will offer you all of your surgery options, answer your questions, and provide you with compassionate care throughout this treatment.

PROS

The autologous tissue from the back of your thigh will give a natural look and feel to the breast that you would not achieve with a prosthetic implant, especially if you only have reconstruction on one breast. Since a PAP flap uses the skin and fat from the inner thigh, it will also leave a nice contour to the thigh.

When you choose to have a PAP reconstruction, you will not have the same complications after the surgery as you would have with breast implants, such as implant rupture, rippling, capsular contracture, or have multiple revision surgeries when the implants need exchanged.

CONS

The PAP surgery can have negative implications as well. The surgery for this procedure is longer, and will require the incisions at several points on the body (breast and thigh). This will mean that you will also have multiple incision points with scarring. However, with PAP surgery, the scarring can be well hidden under the crease of the buttocks. Keep in mind that there could potentially be a risk of infection. There is also a chance that the PAP surgery may fail, and would require additional surgeries to correct the reconstruction, which may still involve the use of silicone or saline implants in the future.

ADDITIONAL INFORMATION

Not all breast cancer patients have reconstructive surgeries, however, we want you to know that you have options. Because of the Women’s Health and Cancer Rights Act of 1998 (WHCRA), if you have a health insurance plan that offers services for mastectomies, then the plan will also be obligated to cover all stages of the reconstructive process, including revision surgeries of previous a reconstruction, symmetry surgeries, and post-mastectomy lymphedema alleviation surgery. Of course, this also means that you will be subjected to the deductible you would pay for mastectomy services.

OUR SURGICAL REQUIREMENTS

The PAP surgery is actually multiple surgeries completed together, which means spending 4 – 7 hours in the operating room. Under anesthesia, the patient will have fat and tissue harvested from the inner thigh. Essentially, this is exactly like what would be taken from the thigh as if the patient were having a thigh lift procedure. The incision will be closed at the crease of the buttocks, and the reconstructive surgeon will then start the reconstruction on the breast. Blood vessels to the flap are preserved, and reconnected at the mastectomy site, and the tissue is positioned at the breast mound. The patient will have incision scarring on the breast.

IN RECOVERY

After both of your procedures, you will be taken to the recovery room where you will be monitored and cared for by our post-operation nursing staff. These nurses will monitor your pain, blood flow with in the new breasts, vital signs, and care for your incisions. This procedure requires a stay in the hospital. We suggest that your recovery period will be 1 – 6 weeks (including periods of breast tenderness), and you should attend all of your follow-up appointments. Strenuous activity should be avoided for a 6-week period, but light activity can begin as early as 4 weeks.

FOLLOW-UP & CONSIDERATIONS AFTER DIEP SURGERY

For best results, you will need to follow all of your reconstructive after-care instructions. You will have a mandatory follow-up appointment in a week after your surgery to check your incision points, your breast blood flow, look for abnormalities, and to assess your progress. Call our office if you have excessive bleeding, fever, or any unusual side effect from the medication, or surgical procedure in your breast or thigh.