Autologous Breast Reconstruction: A Comparative Analysis of DIEP, PAP, and Latissimus Dorsi Flap Techniques
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Abstract
Autologous breast reconstruction has become a cornerstone in post-mastectomy rehabilitation, offering superior aesthetic and psychological outcomes compared to implant-based techniques. Among the various perforator flap options, the Deep Inferior Epigastric Perforator (DIEP), Profunda Artery Perforator (PAP), and Latissimus Dorsi (LD) flaps represent the most widely utilized approaches, each with distinct advantages and limitations. This article provides a comprehensive review of these techniques, focusing on vascular anatomy, surgical morbidity, flap viability, donor-site morbidity, and patient-reported outcomes. The DIEP flap, considered the gold standard for autologous reconstruction, offers abundant tissue volume and low donor-site morbidity but requires advanced microsurgical expertise. The PAP flap, a more recent innovation, provides a favorable alternative with minimal functional impairment, particularly in patients with inadequate abdominal tissue. The LD flap, while less commonly used as a purely autologous option, remains valuable in select cases due to its reliability and versatility, particularly in combination with implants or fat grafting. Through a critical evaluation of current evidence, this review aims to guide surgeons in selecting the optimal reconstructive approach based on patient anatomy, comorbidities, and desired outcomes.
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References
I. American Cancer Society. Key Statistics for Breast Cancer. 2024 Available online: https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html
II. Fortunato L, Loreti A, Cortese G, et al. Regret and Quality of Life After Mastectomy With or Without Reconstruction. Clin Breast Cancer 2021;21:162-9. 10.1016/j.clbc.2019.11.005
III. Souto LRM. Invited Discussion on: The Impact of Reconstructive Modality and Postoperative Complications on Decision Regret and Patient-Reported Outcomes following Breast Reconstruction. Aesthetic Plast Surg 2022;46:661-6. 10.1007/s00266-021-02706-5
IV. Miseré RM, van Kuijk SM, Claassens EL, et al. Breast-related and body-related quality of life following autologous breast reconstruction is superior to implant-based breast reconstruction - A long-term follow-up study. Breast 2021;59:176-82. 10.1016/j.breast.2021.07.003
V. Ribuffo D, Cigna E, Gerald GL, et al. Iginio Tansini revisited. Eur Rev Med Pharmacol Sci 2015;19:2477-81.
VI. Yang JD, Huh JS, Min YS, et al. Physical and Functional Ability Recovery Patterns and Quality of Life after Immediate Autologous Latissimus Dorsi Breast Reconstruction: A 1-Year Prospective Observational Study. Plast Reconstr Surg 2015;136:1146-54. 10.1097/PRS.0000000000001769
VII. Lee JS, Park E, Lee JH, et al. Alteration in skeletal posture between breast reconstruction with latissimus dorsi flap and mastectomy: a prospective comparison study. Gland Surg 2021;10:1587-97. 10.21037/gs-21-31
VIII. Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 1995;96:1608-14. 10.1097/00006534-199512000-00014
IX. Saint-Cyr M, Nagarkar P, Schaverien M, et al. The pedicled descending branch muscle-sparing latissimus dorsi flap for breast reconstruction. Plast Reconstr Surg 2009;123:13-24. 10.1097/PRS.0b013e3181934838
X. Kim H, Eo P, Ryu JY, et al. Boomerang latissimus dorsi flap in immediate or delayed breast reconstruction. Gland Surg 2023;12:894-904. 10.21037/gs-22-664
XI. Koh E, Watson DI, Dean NR. Quality of life and shoulder function after latissimus dorsi breast reconstruction(☆). J Plast Reconstr Aesthet Surg 2018;71:1317-23. 10.1016/j.bjps.2018.05.011
XII. Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982;69:216-25. 10.1097/00006534-198202000-00006
XIII. Healy C, Allen RJ, Sr. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg 2014;30:121-514.Lee KT, Mun GH. A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer. Plast Reconstr Surg 2014;134:303-14. 10.1097/PRS.0000000000000365
XIV. Steffenssen MCW, Kristiansen AH, Damsgaard TE. A Systematic Review and Meta-analysis of Functional Shoulder Impairment After Latissimus Dorsi Breast Reconstruction. Ann Plast Surg 2019;82:116-27. 10.1097/SAP.0000000000001691
XV. Löfstrand J, Paganini A, Grimby-Ekman A, et al. Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study. Br J Surg 2024;111:znad296. 10.1093/bjs/znad296
XVI. Haddock NT, Lakatta AC, Teotia SS. "Categorizing Patient Selection, Outcomes, and Indications in a Decade of 405 PAP Flaps". Plast Reconstr Surg 2023. doi: . 10.1097/PRS.0000000000011052
XVII. Haddock NT, Lakatta AC, Teotia SS. Bilateral LAP Flaps for Breast Reconstruction: A Perforator Classification System. Plast Reconstr Surg 2023. doi: . 10.1097/PRS.0000000000011002
XVIII. Myers PL, Nelson JA, Allen RJ, Jr. Alternative flaps in autologous breast reconstruction. Gland Surg 2021;10:444-59. 10.21037/gs.2020.03.16
XIX. Haddock NT, Teotia SS. Modern Approaches to Alternative Flap-Based Breast Reconstruction: Stacked Flaps. Clin Plast Surg 2023;50:325-35. 10.1016/j.cps.2022.10.008