Stacked profunda artery perforator flaps for unilateral breast reconstruction: a case report

A patient with a severe case of Poland syndrome presented with a painful capsular contracture from a previous implant-based breast reconstruction. She desired the implant to be removed and to proceed with autologous reconstruction, sizeable enough to match the volume of her contralateral breast. A paucity of abdominal donor tissue combined with the patient's hesitancy to acquire an anterior scar excluded this location as a free tissue transfer option. As an alternative donor site, the profunda artery perforator (PAP) flap was chosen. Bilateral PAP flaps were harvested and stacked using anterograde and retrograde anastomoses to the internal mammary vessels. Enough volume was present to fill her chest wall concavity and provide adequate projection to achieve symmetry with her contralateral breast. Her donor sites healed well and remained inconspicuous, without generating difficulties sitting. In conclusion, stacked PAP flaps provide an excellent alternative to an abdominal donor site for achieving large volume unilateral breast reconstruction.