Secondary Autologous Flap Sites: PAP and LAP Flaps
The DIEP flap, which uses tissue from the lower abdomen, is the most widely performed autologous breast reconstruction procedure and the gold standard for natural tissue reconstruction. It offers reliable volume, favorable scarring, and a low complication rate.
But not every patient is a candidate. Some patients do not have enough abdominal tissue to match their breast volume. Others have had prior abdominal surgery, such as a tummy tuck, that compromises the blood vessels needed for the flap. For these patients, alternative donor sites can achieve excellent results.
We consider the PAP flap (Profunda Artery Perforator) and the LAP flap (Lumbar Artery Perforator) the two best alternatives. Drs. Weichman and Thanik have extensive experience with both, and have been involved in advancing PAP flap surgery since its earliest cases.
PAP flap
The PAP flap uses tissue from the posterior thigh. First described around 2010, it is a form of microsurgery breast reconstruction particularly well suited to thinner patients seeking smaller-volume reconstruction. The donor site scar sits in the natural crease below the buttock or along the inner thigh, where it is well concealed, and long-term outcomes are consistently good.
LAP flap
The LAP flap is a newer option that uses tissue from the lower back and "love handle" area. It typically provides more volume than the PAP flap, making it a strong choice for patients who need larger reconstructions or who lack sufficient tissue at other donor sites.
LAP flap surgery is more technically demanding than other autologous procedures. It requires vascular grafts, typically harvested from the abdomen, which adds complexity. Recovery is longer and the overall complication rate is slightly higher than with DIEP or PAP flaps. It is best suited to well-informed, motivated patients who are committed to reconstruction without implants and who have discussed the trade-offs in detail with their surgeon.
Autologous Breast Reconstruction
Implant Based Breast Reconstruction
Secondary Procedures
Cosmetic Procedures
our philosophy
After years in clinical practice, we have watched patients complete treatment, receive a clean bill of health, and still feel like strangers in their own bodies. Fragmented care, time-pressured appointments, and a healthcare system focused on disease management rather than whole-person recovery leaves too many people stranded between surviving and truly living.
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