SP24. The Profunda Artery Perforator Flap in Breast Reconstruction: Long-term Outcomes, Risk Factors and Comparison with Other Flaps

PURPOSE: Despite the growing popularity of the profunda artery perforator (PAP) flap in breast reconstruction, there is limited evidence regarding its long-term outcomes, particularly when compared to other flaps. We present our experience with PAP flaps in breast reconstruction, focusing on long-term outcomes, risk factors for adverse events, and a comparison to other flaps. METHODS: We conducted a retrospective cohort study of consecutive patients who underwent mastectomy and microvascular breast reconstruction from January 2016 to April 2022. Primary outcome was any breast-related complication. Secondary outcomes were 30-day readmission and reoperation. RESULTS: We identified 78 breasts with PAP reconstruction and 1562 with non-PAP reconstruction. Those with PAP reconstruction had mean age of 51.2±10.0, mean body mass index (BMI) of 26.1±5.6, and mean follow-up of 14.9±13.3 months. Twenty-four percent (n=19) of PAP reconstructions developed a breast-related complication, 9.0% were readmitted within 30-days, and 9.0% required reoperation. Mean hospital stay was 4.4±0.9 days. Wound dehiscence was the most common complication (18.0%, n=14), followed by skin flap necrosis (7.7%), hematoma (5.1%), and infection (3.9%). None of the PAP reconstructions developed total flap loss. On multivariable regression, BMI was associated with surgical complications (OR, 1.12; p=0.027). Compared with other flaps, PAP reconstructions were associated with a higher risk of wound dehiscence (OR, 1.93; p=0.041), but operative time (β, 26.4; p=0.161) and the risk of other complications (OR, 0.98; p=0.932) was not increased. CONCLUSION: The PAP flap provides comparable long-term outcomes in breast reconstruction to other flaps; however, the risk of wound dehiscence is significantly higher.