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 upper thigh, to reconstruct the breast. Because no muscle is used, a PAP flap is considered a muscle-sparing type of flap.
With this type of reconstruction, a section of skin, fat, and blood vessels is cut from the back of your upper thigh, just below the buttocks, 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.
Because skin, fat, and blood vessels are moved from your thigh to your chest, having a PAP flap means your thigh will be tighter -- as if you had a thigh lift. PAP flap scars are hidden in the crease of your thigh and buttocks. If PAP flap surgery is used to reconstruct one breast, there could be some unevenness in the back thighs. If you want to avoid this, talk to your surgeon about other options. (A newer type of DIEP surgery, called “stacked DIEP,” is often a good option for women with not enough belly tissue for standard DIEP. However, this surgery is not widely available.) If you’re having both breasts reconstructed, though, your surgeon would take a PAP flap from both thighs, which means both thighs would be thinner. PAP flap surgery is possible even if you’ve had previous liposuction on the thighs.
Learn more about PAP flap reconstruction on these pages: