Lumbar Artery Perforator Flap: Initial Experience with Simultaneous Bilateral Flaps for Breast Reconstruction

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• The lumbar artery perforator (LAP) flap is an alternative for breast reconstruction when the deep inferior epigastric perforator flap is not feasible.
• Bilateral breast reconstruction with LAP flaps is often staged due to positioning and ischemia time concerns.

Purpose of the Study:

• To evaluate the safety and feasibility of performing simultaneous bilateral breast reconstruction using LAP flaps.
• To present early experiences with this innovative technique.

Main Methods:

• Retrospective review of patients undergoing breast reconstruction with LAP flaps (December 2018 - September 2019).
• Data collected included demographics, flap details, and complications.
• Surgical sequence for simultaneous bilateral reconstruction was analyzed.

Main Results:

• Thirty simultaneous bilateral breast reconstructions were performed using LAP flaps.
• One flap loss occurred in a patient with undiagnosed hypercoagulability.
• Average operative time was 510 minutes, with an average ischemia time of 90.3 minutes.
• All flaps utilized a composite deep inferior epigastric arterial/venous graft.

Conclusions:

• Simultaneous bilateral LAP flap breast reconstruction can be safely performed in a single stage.
• This technique is technically challenging and requires a coordinated team approach.
• Prolonged ischemia time and potential for vasospasm necessitate caution and possible intraoperative revisions.