Stacked profunda artery perforator flaps with intra-flap anastomosis for moderate to large breast autologous reconstruction

Background The profunda artery perforator (PAP) flap is a reliable alternative for autologous breast reconstruction; however, the amount of tissue provided is quite limited. For medium to large sized breast reconstruction two PAP flaps can be harvested and inset in "stacked" fashion. This procedure consists in placing the two flaps side by side, normally supplied by antegrade and retrograde anastomoses performed with the mammary vessels. In the present article, we report the employment of stacked PAP flaps with intra-flap anastomosis in breast reconstruction setting. Patients and methods From April 2018 to December 2021, seven patients received unilateral breast reconstruction with stacked PAP flaps. Patients' average age was 47.5 (range 39-58 years old). Mean body mass index was 19.4 kg/m(2) (range 18.5-20.1 kg/m(2)). The two flaps were linked by means of intra-flap anastomosis resorting to side branches of one of the two pedicles. In all cases the internal mammary vessels were dissected sparing the ribs and used as recipient vessels for antegrade end-to-end anastomosis. Results The flaps size ranged from 15 cm x 6 cm to 20 cm x 7 cm with an average weight of 250 g (range 190-290 g). The mean pedicle length was 11.1 cm (range 10-12.5 cm) on the left side and 7.9 cm (range 7-9 cm) on the right side. All flaps survived completely after surgery. The donor sites were all primarily closed with no morbidities. The mean follow-up was 8 months (range 6-12 months). All patients were satisfied with the result. Conclusions Stacked PAP flaps performed with intra-flap anastomosis may represent a valid alternative solution for the reconstruction of moderate to large breast in case of unavailable abdominal tissue.