Matsumine Hajime, Niimi Yosuke, Sakurai Hiroyuki
From the Department of Plastic and Reconstructive Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo 162-8666, Japan.
Plast Reconstr Surg Glob Open. 2025 Jun 26;13(6):e6933. doi: 10.1097/GOX.0000000000006933. eCollection 2025 Jun.
The profunda artery perforator (PAP) flap, harvested from the medial aspect of the thigh, is increasingly used for breast reconstruction because of its low donor-site morbidity and ease of harvest. However, the PAP flap has a limited fat volume, which makes it difficult to use in women with larger breasts. To overcome this limitation, we have developed the "gull-wing stacked" PAP flap, which combines 2 PAP flaps with the aim of achieving adequate volume, projection, and aesthetic outcomes. We performed skin-sparing mastectomy followed by immediate reconstruction using 2 PAP flaps in 3 patients (aged 47-50 y) with unilateral breast cancer. Both thighs were used as donor sites. The flaps were sutured proximally and rotated in opposing directions, mimicking a gull-wing door motion, to create a rounded breast. The internal mammary vessels were chosen as the recipient vessels, with vascular anastomoses performed in an antegrade or retrograde manner. All flaps survived without vascular complications or the need for reoperation. The transferred tissue provided adequate volume and projection, eliminating the need for additional fat grafting. Aesthetic outcomes were deemed excellent in all cases. The gull-wing stacked PAP flap is a promising option for patients who are ineligible for an abdominal flap because of previous surgery or other factors. This method effectively replicates the shape of the breast using a unique flap configuration but requires an extended operation time and significant surgical staffing. Further studies are necessary to optimize the procedure and evaluate long-term outcomes.
股深动脉穿支（PAP）皮瓣取自大腿内侧，因其供区并发症少且易于切取，越来越多地用于乳房重建。然而，PAP皮瓣的脂肪量有限，这使得它难以用于乳房较大的女性。为克服这一局限性，我们开发了“海鸥翼堆叠”PAP皮瓣，它结合了两个PAP皮瓣，旨在实现足够的体积、突出度和美学效果。我们对3例（年龄47 - 50岁）单侧乳腺癌患者进行了保留皮肤的乳房切除术，随后立即使用两个PAP皮瓣进行重建。双侧大腿均作为供区。皮瓣在近端缝合，并以相反方向旋转，模拟海鸥翼门的运动，以形成圆润的乳房。选择胸廓内血管作为受区血管，采用顺行或逆行方式进行血管吻合。所有皮瓣均存活，无血管并发症，无需再次手术。转移的组织提供了足够的体积和突出度，无需额外的脂肪移植。所有病例的美学效果均被认为极佳。对于因既往手术或其他因素而不符合腹部皮瓣条件的患者，海鸥翼堆叠PAP皮瓣是一个有前景的选择。这种方法使用独特的皮瓣构型有效地复制了乳房的形状，但需要延长手术时间和大量手术人员。有必要进一步研究以优化该手术并评估长期效果。
