Bilateral Lumbar Artery Perforator Flaps for Breast Reconstruction: A Perforator Classification System

Area of Science:

• Plastic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Autologous breast reconstruction techniques are evolving, with a continuous search for optimal donor sites.
• The lumbar artery perforator (LAP) flap is an emerging option in reconstructive surgery.

Purpose of the Study:

• To present a classification system for lumbar artery perforator (LAP) flaps.
• To evaluate the outcomes of 108 consecutive simultaneous LAP flaps in autologous breast reconstruction.

Main Methods:

• Retrospective review of 108 simultaneous bilateral LAP flaps.
• Assessment of perforator patterns using CT angiography (CTA).
• Data collection on patient demographics, ischemia times, pedicle length, graft size, and donor-site complications.

Main Results:

• A total of 54 patients (108 flaps) were analyzed.
• Mean ischemia times were 130 minutes for flaps and 300.6 minutes for grafts.
• Donor-site complications included seromas (19%), hematomas (11%), and infections (4%).
• The overall flap loss rate was 2.8%.
• A CTA-directed perforator classification system was developed, categorizing vascular pedicle patterns into types 1-4.

Conclusions:

• The proposed CTA-directed anatomic perforator classification system aids in preoperative planning and surgical execution.
• Simultaneous LAP flaps are a viable and successful option for autologous breast reconstruction, particularly for patients not candidates for other flap types.