The profunda artery perforator flap in autologous breast reconstruction: a scientific review

In oncologic breast reconstruction, autologous techniques have been demonstrated to provide patients with improved long-term outcomes and fewer complications than implant-based techniques, especially in the setting of adjunct therapies. While the deep inferior epigastric perforator (DIEP) flap remains the gold standard, not all patients are suitable candidates due to insufficient abdominal tissue or prior abdominal surgeries. Recent advances in microsurgical and imaging techniques, such as computed tomography angiography (CTA) for perforator mapping, have provided reconstructive surgeons with the ability to reliably harvest perforator-based flaps from various areas of the body that minimize donor site morbidity while maximizing reconstructive success. The profunda artery perforator (PAP) flap has emerged as a useful tool in the reconstructive microsurgeon's armamentarium for breast reconstruction in patients where more traditional donor sites are inappropriate or unavailable. Harvested from the posteromedial thigh, this fasciocutaneous flap preserves underlying muscle function and offers distinct advantages, including a reliable vascular pedicle and a discreetly hidden scar. This review article outlines the development of the flap, recent modifications, and relevant surgical anatomy, ultimately synthesizing current clinical outcomes to validate the PAP flap as a robust and aesthetically superior alternative for restoring natural breast contour.