Plastic Surgery
An Innovative Breast Reconstruction Method: The PAP Flap
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Oct 17, 2017 - 5:33:47 PM

(HealthNewsDigest.com) - DALLAS – Oct. 17, 2017 – When Carla Forbes was diagnosed with breast cancer last year, the retired elementary school principal didn’t think twice about opting for a bilateral mastectomy. “I lost my mom to the disease,” she said. “I just didn’t want to leave anything to chance.”

She had no interest in reconstructive surgery, but her breast surgeon convinced her to see Dr. Nicholas Haddock, Associate Professor of Plastic Surgery and Orthopaedic Surgery at UT Southwestern.

“She said, ‘I think you owe it to yourself to at least go talk to him,’” Ms. Forbes recalled. “My mind was pretty made up that reconstructive surgery wasn’t something I was going to do. And as much as anything, I didn’t want to waste his time.”

Ms. Forbes, 57, didn’t want to go through any extra surgeries and she had friends who had endured complications with breast implants. She didn’t realize there were other options.

“Dr. Haddock started presenting what he would recommend and said that I would be ideal for this PAP procedure. It totally blew my mind because I had no idea that things like that were even possible,” she said.

“As he explained this cutting-edge procedure that he helped pioneer, it sounded frightening. But it was also really amazing to think it was possible. It took away one of the main reasons I thought I wouldn’t do anything like that: It’s using all your own tissue, it’s natural, and it’s safe.”

The profunda artery perforator (PAP) flap procedure involves using a patient’s thigh tissue for breast reconstruction. “It is our second choice when using a patient’s own tissue for breast reconstruction,” Dr. Haddock said. “Typically our primary choice is the tummy, as a DIEP flap, but there are patients who don’t have enough tissue on their tummy or who have had surgeries before and then that source is not available, so the PAP flap becomes our best option in that situation.”

Women who want to have children or have already used abdominal tissue for breast reconstruction are good candidates for PAP flaps, as are those who are exercise enthusiasts or avid runners – like Ms. Forbes.

PAP flaps were first used in reconstructive surgeries involving pressure sores, burns, and extremity wounds. The technique was applied to breast reconstruction in 2012 by Dr. Robert Allen, Clinical Professor of Plastic Surgery at New York University Medical Center, and Dr. Haddock, who completed his residency in plastic surgery at the Institute of Reconstructive Plastic Surgery at NYU Langone Medical Center.

“I did the first one with Dr. Allen and then I brought it here, and we are really the two groups that have done the most in the world,” Dr. Haddock said. “We continue to present around the world on this.”

Dr. Haddock is lead author of “101 Consecutive Profunda Artery Perforator Flaps in Breast Reconstruction – Lessons Learned with Our Early Experience” published in Plastic and Reconstructive Surgery. UTSW co-authors on the study are Dr. Sumeet Teotia, Associate Professor of Plastic Surgery and Director of the Breast Reconstruction Program, and Dr. Min-Jeong Cho, a resident.

“It’s one of the largest series that has been published on the PAP flap,” he said. “At the time of the publication, we’d only done 101 flaps, but now we’ve done over 175. We go through lessons learned and we provide a video, which has not been available before.”

The study concludes that the PAP flap is a safe and reliable option for breast reconstruction and it also can be combined with other flaps when additional volume or skin is needed. It provides patients with another option.

That was good news for Ms. Forbes. When she was making her decision about whether to do reconstructive surgery, she received words of wisdom from her nephew, Cameron Forbes, who characterized the success of the surgery as the difference between surviving and thriving.

Ms. Forbes had her mastectomy in April 2016 and her PAP flap reconstructive surgery that August. A year later, she’s feeling like herself again, walking and running 4 to 5 miles a day and enjoying time with friends and family. She recently relocated from Plano, Texas, to Destin, Fla.

“Without a doubt, I’m glad that I did it. It’s given me my freedom and I’m thriving,” she said. “I look and feel like a better version of myself, and I’m confident that nobody can look at me and tell that I have been through this horrific thing. And if somebody knows it, it’s only because I’ve chosen to tell them. And I like that.”

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