L-shaped profunda artery perforator flap for breast reconstruction in thin patients

The profunda artery perforator flap is suitable for cases where the breasts are small and there is insufficient abdominal fat for harvest. Two designs for this flap have been reported, vertical and horizontal, but to our knowledge, no consensus exists on the optimal design. This study presents surgical procedures using an L-shaped design and evaluates postoperative cosmetic outcomes retrospectively. A retrospective cohort study of breast reconstruction using this method by a single surgeon was conducted over 5 years. One year after surgery, the Telemark breast score was used to evaluate breast and donor-site aesthetics. Patient satisfaction was assessed using the Breast-Q. Eight patients underwent breast reconstruction using this design. The mean body mass index was 19.6 ± 1.7 kg/m², and the mean harvested flap weight was 233.6 ± 51.4 g. One patient developed partial necrosis; the remaining seven had satisfactory outcomes. There was no significant difference in median Telemark breast scores between the affected and unaffected sides one year postoperatively (15.00 [14.00–17.00] vs. 15.00 [14.00–17.00], p = 0.679). Donor-site cosmetic outcomes were good. Breast-Q results were comparable to those reported for other reconstruction methods. To our knowledge, this is the first consecutive case series evaluating outcomes of the L-shaped profunda artery perforator flap. The technique may allow adequate breast shaping, including upper-pole filling, in patients with limited upper body fat, with relatively inconspicuous donor-site scars. However, these findings should be interpreted in light of the retrospective design and small sample size. Level IV, therapeutic study.