(A) A lumbar artery perforator flap (LAP flap) uses the soft tissue of the waistline at the lower back and the flank (the “love-handle” area) to reconstruct a breast. (B) A LAP flap is shown here being surgically elevated; as is the case with all perforator flaps, muscle remains intact at the flap’s donor site. Because of the location from with tissue is borrowed, LAP flap surgery lifts the buttock and contours the waistline. (C) The scar that results from harvest of a LAP flap lies along the waistline at the junction of the lower back and buttock where it can be concealed by most clothing and bathing suits. Once removed from the donor site, a LAP flap is transferred to the chest (not shown) and blood flow to the newly reconstructed breast is established using microsurgical techniques. The scar that results on the breast will depend on the technique of mastectomy. When just one breast is reconstructed with a LAP flap, the opposite side of the lower back is contoured to produce symmetry.
Using tissue from the region just above the buttock to reconstruct the breasts can be an excellent option when personal preference, the shape of one’s body or a history of prior surgery make this area a more appealing donor site. Using Lumbar Artery Perforator (LAP) flaps, it is possible to reconstruct a woman’s breasts with soft tissue harvested from the lower back and hip—“love-handle”—areas. Since excess skin and fatty tissue are removed along the waistline, similar to that which is removed during cosmetic buttock-lift surgery, the buttocks end up in a higher position with these procedures. The scar that results from harvest of a LAP flap can generally be well concealed along the waistline where the buttock and lower back meet making this an appealing option for many women.
The blood vessels that are needed for a LAP flap are meticulously dissected without removing any muscle. Since muscle is neither divided nor removed when harvesting a LAP flap, postoperative discomfort is minimized. After a LAP flap is transferred to the chest, the blood vessels of the flap are connected to blood vessels at the mastectomy site using an operating room microscope. The skin and fat of the LAP flap are then shaped into a new breast.
Approximately three months after the initial stage of breast reconstruction surgery, reconstruction of your nipples (when mastectomy includes their removal), refinement of breast shape and procedures to produce symmetry with your untreated breast can be completed. These optional additional procedures are performed on an outpatient basis and are referred to as Stage II.
Because the tissue used for lumbar artery perforator flap breast reconstruction is similar to that removed during a buttock lift, women who undergo this procedure generally experience an improvement in the contour of their waistline and experience a degree of buttock lift. When just one breast is reconstructed using a LAP flap, tissue can be removed from the opposite side of the body to produce symmetric contours of the waistline and buttock. The scars that result from this type of surgery can typically be concealed in most clothing and in a one-piece bathing suit.
Contact us if you would like more information about LAP flaps for breast reconstruction or for information about other options for breast reconstruction including DIEP flap surgery or breast reconstruction using breast implants after mastectomy. Our practice has offices in New York City and Fairfield County, Connecticut.