PAP stands for profunda artery perforator, a blood vessel that runs through your thigh. A PAP flap uses this blood vessel, as well as a section of skin and fat from the back of your inner thigh, to reconstruct the breast. Because no muscle is used, a PAP flap is considered a muscle-sparing type of flap.
PAP flap may be combined with DIEP flap as QUAD flap procedure to enhance the reconstructed breast volume when there is not sufficient volume from either procedure.
With this type of reconstruction, a section of skin, fat, and blood vessels is cut from the inner thigh and posterior thigh skin and fat tissue under buttock crease and moved up to your chest to rebuild your breast. Your surgeon carefully reattaches the blood vessels of the PAP flap to the blood vessels in your chest using microsurgery.
The PAP flap may be a good reconstruction option for women who don’t have enough belly tissue for reconstruction, either because they are very thin or had major abdominal surgeries, and are not good candidates for TRAM, DIEP, or SIEA flaps. It also tends to work better for women with small- to medium/small-sized breasts. If you have larger breasts and your doctor recommends PAP flap reconstruction because of your unique situation, you may need a saline or silicone implant to achieve your desired size.