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

The lumbar artery perforator (LAP) flap has emerged as a reliable option for autologous breast reconstruction in patients lacking suitable abdominal donor tissue. This study presents a comprehensive 7-year institutional analysis of 300 LAP flaps, examining patient selection, surgical outcomes, temporal trends, and patient-reported outcomes.

A retrospective review of all LAP flap breast reconstructions between December 2018 and May 2025 was performed. Patients were categorized by reconstruction type: unilateral, bilateral, and stacked LAP flaps. Complications, operative characteristics, and BREAST-Q outcomes were analyzed. Bilateral LAP flaps were further stratified into four temporal cohorts to assess changes over time.

A total of 300 LAP flaps were performed in 162 patients, including 107 bilateral, 21 unilateral, 31 bilateral stacked, and 3 unilateral stacked reconstructions. Overall complication rates for non-stacked LAP flaps decreased from 30.2% in 2019 to 8.8% by 2024-2025, despite a more than threefold rise in annual case numbers. BREAST-Q scores demonstrated sustained improvements across all domains, including satisfaction with breasts, psychosocial and sexual well-being, and physical well-being of the chest. Stacked LAP flaps were associated with significantly higher complication rates (45.2-66.7%) compared to standard LAP flaps (23.4-28.6%, P = 0.043), particularly in patients with elevated BMI and diabetes.

As microsurgical experience with LAP flaps grows, institutional complication rates markedly decline over time, making LAP flaps a safe and effective option for autologous breast reconstruction. LAP flaps yield durable reconstructive outcomes and sustained improvements in patient-reported satisfaction and quality of life.