title: Breast Reconstruction Using the Geometrically Modified Profunda Artery Perforator Flap From the Posteromedial Thigh Region: Combining the Benefits of Its Predecessors.
abstract: BACKGROUND
  Occasionally, the deep inferior epigastric perforator flap is unavailable for autologous breast reconstruction. Alternative options, such as gluteal artery perforator flaps, the transverse upper gracilis flap, and the profunda artery perforator (PAP) flap, have been well documented. In our initial experience, the PAP flap was associated with limitations at the donor site. Therefore, a geometrically modified PAP flap was evaluated.
  
  
  METHODS
  Forty geometrically modified PAP flap reconstructions were performed on 30 patients. Our modification comprised flap harvest from a more cranial area, hereby adding abundant inferior gluteal tissue to the flap while sparing superior thigh tissue. Patient characteristics, anatomical variables, and clinical outcome were prospectively evaluated.
  
  
  RESULTS
  Mean patient age was 44 years, and mean body mass index (BMI) was 23.3 kg/m. Mean flap size was 32 × 12 cm, and mean weight was 385 g. Mean number of suitable perforators (diameter ≥ 0.5 mm) in the adductor magnus area was 1.7 per thigh. All flaps survived completely. Wound dehiscence at the donor site occurred after 4 unilateral reconstructions. Transient lymphedema of the leg occurred after 4 other unilateral reconstructions. Other wound morbidity or systemic complications did not occur. Secondary breast surgery for symmetry and volume was indicated after 16 reconstructions. Preoperative bra size was unchanged or larger in 36 reconstructions. Scar position in the crease was achieved after 39 reconstructions. Sensibility changes of the posteromedial thigh region were not observed.
  
  
  CONCLUSIONS
  The geometrically modified PAP flap ensures in-the-crease scar positioning and provides sufficient tissue to restore preoperative bra size.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center (Radboudumc), Geert Grooteplein-Zuid 10, Nijmegen, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Hupkens
authors.forename: Marijn
authors.initials: M
authors.lastname: Hameeteman
authors.forename: Pèdrou B
authors.initials: PB
authors.lastname: Westland
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Slater
authors.forename: Dalibor
authors.initials: D
authors.lastname: Vasilic
authors.forename: Dietmar J O
authors.initials: DJ
authors.lastname: Ulrich
mesh_terms: D000328:Adult; D001158:Arteries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061525:Perforator Flap / Q000098:blood supply*; D011446:Prospective Studies; D013848:Thigh / Q000098:blood supply* / Q000601:surgery