Profunda Artery Perforator Flap for Autologous Breast Reconstruction: A Review of the Evidence and the Linkou Chang Gung Memorial Hospital Experience

This study aimed to summarize and highlight institutional experience on the profunda artery perforator (PAP) flap for autologous breast reconstruction. Contemporary series demonstrate high flap success and patient satisfaction with PAP reconstruction. Key technical evolutions include perforator-targeted skin paddle designs, strategies to augment venous outflow when needed, and standardized donor site management. Comparative studies and systematic reviews suggest reconstructive reliability comparable to other autologous options, while donor site wound morbidity remains the main area for optimization. In the low-body mass index (BMI) Asian cohort, PAP reconstruction achieved high success, and closed-incision negative pressure wound therapy (iNPWT) reduced donor site wound complications. The PAP flap is a versatile alternative when the abdomen is unsuitable, particularly for small-to-moderate volume breast reconstruction. Outcomes are optimized by careful patient selection, perforator mapping, thoughtful flap design, proactive venous outflow planning, and meticulous donor site closure. Stacked/Bilateral PAP strategies and staged fat grafting expand indications when a single flap is unlikely to meet volume requirements.