The "Pap Flap" Reconstructive Option for Breast Cancer
For many with breast cancer, surgery to remove the breast is lifesaving. However, that does not mean it comes without its intense difficulties - both emotionally and physically. Many women opt to reconstruct the breast, but unfortunately some cannot use implants. "The Pap Flap" is a surgical procedure for reconstruction that takes skin and fat from the thigh and moves it to the breast, and has been an excellent and needed option to those who could not have reconstruction done in another manner.
A necessary alternative
Breast reconstruction is usually done by breast implants or fat and skin being transferred from the area of the lower abdomen. However, not every patient is a candidate for these specific procedures. For example, Brandi Supernant.
Brandi had very few options when it came to her treatment of breast cancer, and was unable to have implants or removal from the lower abdomen. She explains why by saying, "you have a lot of skin inflammation after and implants sometimes do not really work well with radiated tissue."
Also, some women like Brandi do not have enough fat in their abdomen to transfer to the breast, resulting in the lack of a source for natural reconstruction. This can occur when women are either very thin, or if they have had major abdominal surgeries.
However, she did not give up, and decided to research alternative options. She eventually found Dr. Michael Alperovich at Smilow Cancer Hospital at Yale New Haven. The three-hundred-mile distance from where she lives did not even dissuade her; she knew he was the doctor for her.
Dr. Alperovich was able to do the "Pap Flap" for Brandi. He explains the procedure, "I compare it to essentially doing a transplant within a patient's body. The Pap Flap essentially is using upper thigh skin and fat and transferring that to create breast tissue. You take the fat from the inner thigh. It essentially starts in the inner thigh and then extends around the back. It's a chance we can now say, any woman regardless of your body type can have an autologous or flap breast reconstruction. It's a chance to have natural reconstruction in the absence of any implants.
For women like Brandi, this is a game changer. Where once she thought she had very limited options and would have to choose between the lesser of evils, she finally was offered a procedure she felt positive about. As a mother of two, she explained, "I wanted something that would make me feel whole again. I was just really looking for something that was more natural that once I was done with surgery I can move on with my life and not have to go back there again."
Because the pap flap is a procedure that her body would not reject, she would not have to worry about constant visits to the hospital after the procedure was over.
Dr. Alperovich explains the plans for Brandi's procedure, "we'd like to do - basically take the fat - that's sort of a little bit of lipo and just contour some little minor changes on the right side."
Although this procedure is proving to be very valuable, it is not to replace the more common procedure of removing skin and fat from the lower abdomen. That is still considered the best option for natural breast reconstruction, except in cases where the patient cannot have a removal done on their abdomen.
How does it work?
Pap actually stands for profunda artery perforator, which is a blood vessel that runs through the thigh. A pap flap is able to utilize this blood vessel, along with some of the skin and fat around the back of the upper thigh during breast reconstruction. However, no muscle is taken, which is why pap flaps are a "muscle-sparing" version of a flap.
The fat, skin, and blood vessels are removed from below the buttocks, on the upper thigh, and moved to the chest by a surgeon who will proceed to reattach the blood vessels of the pap flap to the blood vessels that are in the chest. This is done by using microsurgery, which is simply a surgery that requires a microscope.
If women do not have enough belly tissue for reconstructive surgeries, they are often barred from being candidates for TRAM, DIEP, or SIEA flaps, so pap flaps become a great option. When women have small or medium/small sized breasts, the operation tends to be most effective. For women who have larger breasts, the personal situation will need to be looked into by your doctor to see if you are a candidate. Sometimes saline or silicone implants will be necessary for the desired size.
Of course, the effect the pap flap has is not only on the breasts. Because the skin, fat, and blood vessels are initially coming from the thigh, it will end up being tighter, some doctors say like a thigh lift. The surgeon will hide the scars between the crease of the thigh and buttocks, making them as minimally noticeable as possible.
In the event that a pap flap is done on only one breast, the back of the thighs may appear uneven. If this is something that is a deterrent for you, it may be a good idea to explore other options instead. One is called a new type of DIEP surgery, which is called a "stacked DIEP." This option has shown to be a good alternative for women who do not have sufficient belly tissue for the standard DIEP to be done. If this interests you, contact your doctor and surgeon; however, at the moment the surgery is not widely available.
However, if you are having both breasts reconstructed, the pap flap would be extracted from both thighs, resulting in both looking thinner with approximately even distribution. Even if you have had liposuction before on your thighs, the pap flap can still be done.
What to expect
So, what should you expect during a pap flap surgery? It usually takes between three and five hours, after which you will be moved to a recovery move where your heart rate, blood pressure, and body temperature will be monitored. Some patients experience pain or nausea from anesthesia, in which case you will have the option of medication. Then, you will be admitted to a hospital room where you'll stay for about three days.
Your doctor will provide you with very specific instructions to be followed during your recovery. It usually takes about four weeks to recover, but you may need to wear a compression girdle for eight weeks. The recovery length is longer than most operations, because the surgery takes place at up to four sites (both thighs, both breasts). This means you will have to care for every incision, possibly including a surgical drain if you require an axillary dissection.
Healing problems can happen at the incision location where the donor tissue was removed, so keep your doctor updated if you think something may feel abnormal.
Do not rush your recovery, and follow your doctor's instructions very carefully. Ask your doctor before beginning exercises, sexual activity, lifting anything heavy, and various other activities.
References
http://wtnh.com/2017/09/07/a-reconstructive-surgical-option-for-women-with-breast-cancer/
http://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/pap
http://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/pap/what-to-expect
