Categorizing Patient Selection, Outcomes, and Indications in 300 Lumbar Artery Perforator Flaps.

Area of Science:

• Microsurgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Lumbar artery perforator (LAP) flap is a viable autologous breast reconstruction method for patients without abdominal donor tissue.
• This 7-year study analyzes 300 LAP flaps, focusing on patient selection, outcomes, trends, and patient-reported results.

Purpose of the Study:

• To evaluate the safety and efficacy of LAP flaps in autologous breast reconstruction.
• To examine temporal trends in complication rates and patient-reported outcomes over a 7-year period.
• To compare outcomes between standard and stacked LAP flaps.

Main Methods:

• Retrospective review of 300 LAP flap breast reconstructions from December 2018 to May 2025.
• Categorization by reconstruction type (unilateral, bilateral, stacked) and analysis of complications and BREAST-Q outcomes.
• Stratification of bilateral LAP flaps into temporal cohorts to assess changes over time.

Main Results:

• Complication rates for non-stacked LAP flaps decreased from 30.2% to 8.8% despite increased case volume.
• BREAST-Q scores showed sustained improvements in satisfaction, psychosocial, sexual, and physical well-being.
• Stacked LAP flaps had higher complication rates (45.2-66.7%) than standard LAP flaps (23.4-28.6%), especially in patients with high BMI and diabetes.

Conclusions:

• Increasing microsurgical experience with LAP flaps leads to declining institutional complication rates.
• LAP flaps provide durable reconstructive outcomes and enhance patient-reported quality of life.
• LAP flaps are a safe and effective choice for autologous breast reconstruction.