Autologous Breast Reconstruction: A Comparative Analysis of DIEP, PAP, and Latissimus Dorsi Flap Techniques

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.