Gon Chika, Karakawa Ryo, Yoshimatsu Hidehiko, Fuse Yuma, Ogawa Rei, Yano Tomoyuki
Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Plastic and Reconstructive Surgery, Nippon Medical School Hospital, Tokyo, Japan.
Microsurgery. 2025 Jul;45(5):e70085. doi: 10.1002/micr.70085.
While autologous breast reconstruction using the profunda femoris artery perforator (PAP) flap is becoming increasingly popular, no aesthetic evaluation has been reported. The aim of this study is to evaluate the reconstructed breast using the PAP flap quantitatively and to clarify which factors contribute to the aesthetically favorable results.
We identified 127 patients who underwent breast reconstructions using the vertically designed PAP flap for unilateral breast cancer between April 2018 and December 2021. The PAP flap was elevated vertically to avoid disrupting lymphatic pathways and was inserted between the pectoralis major muscle and the subcutaneous fat after the anastomoses. We classified cases into two groups: the "Favorable cosmesis group" and the "Unfavorable cosmesis group" based on aesthetic evaluations using the vectra three-dimensional (3D) imaging system. Patient characteristics and outcomes between two groups were compared.
Of the 127 patients, 15 were excluded: three with stacked PAP flaps, two with flap necrosis, and 10 with missing aesthetic outcome data. Among the remaining 112 patients, 18 were classified in the "Favorable cosmesis group" and 94 in the "Unfavorable cosmesis group." Comparative analysis revealed that the "Favorable cosmesis group" showed significantly higher ratio with small volume in the upper pole of the unaffected side (21% vs. 72%, p < 0.01) and had a smaller final inset flap weight (147 vs. 190 g, p = 0.028) compared to the "Unfavorable cosmesis group." All 112 patients were evaluated using vectra 3D system at 12 months postoperatively, and their postoperative flap courses were uneventful.
In our study, inherent small volume of the upper pole and smaller flap inset weight contribute to more favorable outcomes.
虽然使用股深动脉穿支（PAP）皮瓣进行自体乳房重建越来越普遍，但尚未见美学评价的报道。本研究的目的是对使用PAP皮瓣重建的乳房进行定量评估，并阐明哪些因素有助于获得美学上满意的效果。
我们纳入了2018年4月至2021年12月期间因单侧乳腺癌接受垂直设计的PAP皮瓣乳房重建的127例患者。PAP皮瓣垂直掀起以避免破坏淋巴通路，吻合后插入胸大肌和皮下脂肪之间。根据使用Vectra三维（3D）成像系统的美学评价，我们将病例分为两组：“美容效果良好组”和“美容效果不佳组”。比较两组患者的特征和结果。
127例患者中，15例被排除：3例皮瓣堆叠，2例皮瓣坏死，10例缺少美学结果数据。在其余112例患者中，18例被归类为“美容效果良好组”，94例被归类为“美容效果不佳组”。对比分析显示，与“美容效果不佳组”相比，“美容效果良好组”患侧上极体积较小的比例显著更高（21%对72%，p<0.01），最终植入皮瓣重量更小（147对190g，p=0.028）。所有112例患者在术后12个月使用Vectra 3D系统进行评估，术后皮瓣过程顺利。
在我们的研究中，上极固有的小体积和较小的皮瓣植入重量有助于获得更满意的效果。
