Gull-wing Stacked Profunda Artery Perforator Flap for Unilateral Breast Reconstruction

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncology

Background:

• The profunda artery perforator (PAP) flap is a valuable technique for breast reconstruction due to minimal donor-site morbidity.
• Limited fat volume of the standard PAP flap restricts its use in patients requiring larger breast volumes.

Purpose of the Study:

• To introduce and evaluate the efficacy of the "gull-wing stacked" PAP flap technique for breast reconstruction.
• To assess the volume, projection, and aesthetic outcomes of this novel flap configuration.

Main Methods:

• A modified technique involving the combination of two PAP flaps was developed.
• Three patients underwent immediate breast reconstruction using the gull-wing stacked PAP flap after skin-sparing mastectomy.
• Flaps were harvested from bilateral thighs and anastomosed to internal mammary vessels.

Main Results:

• All three reconstructed breasts achieved adequate volume and projection without additional fat grafting.
• Excellent aesthetic outcomes were reported in all patients.
• No vascular complications or need for reoperation occurred.

Conclusions:

• The gull-wing stacked PAP flap is a viable and effective option for breast reconstruction, particularly for patients with contraindications to abdominal flaps.
• This technique provides superior volume and projection, mimicking natural breast shape.
• Further research is needed to optimize the procedure and assess long-term results.