Patient-reported and surgical outcomes of profunda artery perforator (PAP) flap breast reconstructions compared to deep inferior epigastric perforator (DIEP) using BREAST-Q

BACKGROUND: Autologous breast reconstruction patients require thorough assessment, with the profunda femoris artery perforator (PAP) flap having become an important autologous reconstruction option alongside the deep inferior epigastric perforator (DIEP) flap. Breast reconstruction impacts patients psychologically, physically and mentally. The BREAST-Q aids in the assessment of patient-reported outcome measures (PROMs). We aim to critically compare postoperative clinical outcomes, aesthetic results, morbidity and patient satisfaction between patients undergoing DIEP and PAP flap reconstructions using clinical follow-up and PROMs.

METHODS: A non-blinded two-armed prospective cohort study was performed. Patients undergoing PAP or DIEP flap reconstructions between January 2021 and February 2022 were included and followed up for at least one-year postoperatively. Demographic and per-operative data were acquired. BREAST-Q data were collected preoperatively and at 2-week, 3-month and 1-year intervals postoperatively.

RESULTS: 157 patients had autologous breast reconstruction (207 flaps), with 129 (82.1%) DIEP patients and 21 (13.3%) PAP patients. 37 (28.6%) patients underwent bilateral DIEP reconstructions, and 1 (5%) PAP case was bilateral. The remaining PAP cases used stacked flaps for unilateral breast reconstruction. Mean ischaemia time for PAP was 55.29 (±15.59 minutes) compared to 69.52 (±21.74 minutes) for DIEP (p = 0.014). Donor site wound dehiscence was significantly higher with PAP reconstructions (p = 0.014).

CONCLUSIONS: At one-year follow-up, no significant differences in PROMs across all domains between DIEP and PAP flap reconstructions were noted. This reflects that PAP flap reconstructions, despite having a more challenging donor site and higher donor site complications, provide an excellent reconstructive option with similar patient-reported outcomes when compared to the gold-standard DIEP flap reconstruction.