Mosaic Fleur-de-Profunda Artery Perforator Flap for Autologous Breast Reconstruction

Abstract

Perforator-free flaps, in autologous breast reconstruction, have expanded to exploit tissue available at smaller donor sites while retaining high success and low risk rates. Abdominal based flaps, such as the deep inferior epigastric perforator, remain the most common; however, when the abdomen is not an appropriate donor site, lower extremity flaps are options. The profunda artery perforator has the benefit of hiding unsightly scar in the gluteal crease but has the drawback of poor donor site volume. Our mosaic fleur-de-profunda artery perforator flap technique for breast reconstruction has shown to increase volume with the addition of a vertical limb, include full angiosome of perforators, and exhibit donor site morbidity equivalent to a medial thigh lift.

Fig. 1.

Patient 1: Preoperative photo after bilateral mastectomy and implant reconstruction failure.

Fig. 2.

Patient 2: Intraoperative skin markings in the lithotomy position.

Fig. 3.

Patient 1: Intraoperative view of 2 profunda artery perforators emerging through adductor magnus, in mosaic branching, to supply both the horizontal and vertical limbs of the flap.

Fig. 4.

Patient 1: Postoperative results of bilateral breast reconstruction, using fleur-de-PAP free flaps, following second-stage procedure and tattooing at 1.5 years. Not shown is the postoperative thigh views of the donor site demonstrating well-hidden scars in inferior gluteal crease and medial thighs that resemble acceptable medial thigh lift results.