PAP Flap and LTP Flap Reconstruction Procedures

PAP and LTP flap reconstruction procedures may be good options for people who are not good candidates for DIEP, SIEA, or TRAM flaps because they don’t have enough tissue in the abdomen or because they’ve already had major abdominal surgeries. PAP flaps and LTP flaps come from different areas of the thighs:

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  PAP, or profunda artery perforator, is named for a blood vessel that runs through the thigh; the flap comes from the back of the upper thigh

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  LTP, or lateral thigh perforator, is named for a blood vessel that runs along the outer thigh; the flap comes from the upper outer thigh (called the saddlebag area)

The PAP flap procedure may make sense for you if you have small- or medium-sized breasts. If you have larger breasts and your doctor recommends PAP flap reconstruction, you may need a saline or silicone implant to achieve your desired size.

The LTP flap procedure may make sense for you if you don’t have enough belly tissue or can’t use any because of scarring from previous major surgeries.

It’s still possible to have either of these thigh flap procedures if you’ve had liposuction on your thighs.

During a PAP flap procedure, surgeons make an incision in the back of the upper thigh just below the buttocks and take skin, fat, and blood vessels to reconstruct the breast. Surgeons then attach the tiny blood vessels in the flap to the blood vessels in the chest using microsurgery.

PAP flap reconstruction is considered a muscle-preserving procedure because surgeons do not cut or remove muscle. After a PAP flap procedure, your thigh feels tighter — as if you’d had a thigh lift.

Because the incision is just below the crease where the thigh and buttocks meet, the scar is relatively hidden.

PAP flap procedures take from three to five hours.

During an LTP flap procedure, surgeons make an incision in the upper outer thigh and take skin, fat, and blood vessels to reconstruct the breast. Surgeons then attach the tiny blood vessels in the flap to the blood vessels in the chest using microsurgery.

LTP flap reconstruction is considered a muscle-preserving procedure because surgeons do not cut or remove muscle. After an LTP flap procedure, your thigh feels tighter — as if you’d had a thigh lift.

The scar runs along the outer thigh and sometimes there is a divot that can be fixed with fat grafting.

LTP flap procedures take from three to five hours.

Each of these thigh flap procedures requires a hospital stay of about three days. Recovery can take about four weeks, although it may be a little longer if you have surgery on both thighs.

Your surgeon may recommend you wear a compression girdle with shorts that cover the upper thigh for up to eight weeks after surgery.

Recovery from PAP flap reconstruction may be a little more difficult than recovery from LTP flap reconstruction because of where the incision is located and the risk of healing issues. Keep the area clean, dry, and protected.

Follow your surgical team’s instructions on when to start stretching exercises and regular daily activities.

Your thighs might look uneven after having any of these thigh flap procedures, especially if only one side is used. 

Health insurance might not cover procedures to correct unevenness in your thighs after surgery. Call your health insurance provider to check. You also may want to ask your surgeon if there’s a way to avoid unevenness or if another type of flap procedure makes more sense for you.

As with any surgical procedure, PAP and LTP flap reconstruction surgery has some risk of necrosis and fat necrosis.