Comparison of DIEP and PAP free flaps for breast reconstruction in the context of breast cancer: A retrospective study of 677 patients over 10 years.

[BACKGROUND] Profunda artery perforator (PAP) flap following cancer surgery has emerged as a relevant alternative for breast reconstruction but is mainly used in cases where the deep inferior epigastric perforator (DIEP) flap cannot be performed. The aim of this study was to compare the PAP and DIEP flaps' surgical and aesthetics outcomes in breast reconstruction.

[METHODS] Women who underwent breast reconstruction by DIEP or PAP flap at the Plastic Surgery Department of Georges Pompidou European University Hospital, Paris, France, between January 2012 and December 2020 were included. Patient's demographic characteristics, type, laterality, and timing of reconstruction were recorded. Operative times, length of hospital stay, general complications, and surgical complications were compared. The number of late surgical reoperations, their timing relative to the initial reconstructive procedure, and their purpose were also compared.

[RESULTS] A total of 677 patients were included, 559 of whom received DIEP flaps and 118 received PAP flaps. PAP flap patients were significantly younger, thinner, and had a smaller initial bra cup size than those who received DIEP (p < 0.001) Operative time was similar for both groups (p = 0.074). There was no difference in the number of early post-operative reoperations (p > 0.554) or late revisions (p > 0.403) between DIEP or PAP.

[CONCLUSION] Provided that the technical and human resources are available, PAP flap is a valid technique, without increased risk of surgical complications and reoperations, or lengthening of operative time. The PAP flap should be considered a primary therapeutic option and not as an alternative to the DIEP flap.