Microsurgical Breast Reconstruction Options After Abdominoplasty: Lumbar Artery Perforator Versus Profunda Artery Perforator

Background: Patients who have undergone abdominoplasty face limited options for microsurgical breast reconstruction, as the deep inferior epigastric perforator flap is often unavailable. This study compared lumbar artery perforator (LAP) and profunda artery perforator (PAP) flaps for microsurgical breast reconstruction in patients with prior abdominoplasty. Methods: A retrospective chart review was conducted on all patients who underwent microsurgical breast reconstruction between January 2011 and May 2023. Data analyzed included demographics, comorbidities, reconstruction type, complications, and patient-reported outcomes measured by BREAST-Q surveys. Statistical analysis used the Pearson χ 2 test and independent samples t test. Results: A total of 264 patients underwent microsurgical breast reconstruction, with 39 having a history of abdominoplasty. Patients with prior abdominoplasty were older (54.4 ± 7.8 versus 50.5 ± 9.1 y, P = 0.012) and had a significantly higher body mass index (28.8 ± 4.4 versus 25.3 ± 4.2 kg/m 2 , P < 0.001). Hypertension (30.8% versus 15.6%, P = 0.023) and diabetes (12.8% versus 4.0%, P = 0.024) were also more common in the abdominoplasty group. Among abdominoplasty patients, LAP flaps were more often undergone (66.7% versus 26.2%, P < 0.001). LAP flap recipients reported significantly higher BREAST-Q scores compared with PAP flap patients (all P < 0.001). Conclusions: The LAP flap emerges as a superior option for microsurgical breast reconstruction in patients with prior abdominoplasty, providing higher patient satisfaction compared with PAP flaps. This study highlights the necessity of personalized, adaptable surgical approaches in microsurgical breast reconstruction, emphasizing patient-specific anatomical and historical considerations to optimize outcomes.