Introduction
Lifestyle plays a crucial role in postoperative recovery after breast reconstruction with autologous free tissue. Nobody better than the same patient can evaluate two different procedures. In rare cases the same patient can develop a contralateral breast cancer following unilateral DIEP breast reconstruction. In these cases the PAP flap can be a suitable and reliable option for the contralateral reconstruction when patient’s preference remains towards autologous tissue. We present the experience of four women who underwent both DIEP flap breast reconstruction to one side and bilateral PAP flaps to the other side at different times.
Methods
Between January 2014 and March 2017, we prospectively recorded demographics, pre/intra and postoperative data of the above patients. Post-operative Breast-Q were administered with a minimum of 6 months from each type of breast reconstruction. Post-operative Breast-Q for the PAP flap’s donor site, was upgraded with extra specific questions.
Results
Patients didn’t experience any flap failure, neither early or long term complications. Mean hospital stay was 6 days regarding DIEP flap and 5 days after PAP flaps. All the patients reported an overall personal preference for PAP flaps with regards to recovery time to get back to normal life (mean 5.4 weeks DIEP vs 4.6 weeks PAPs) and postoperative pain (mean NRS scale pain 3.2 for DIEPs and 2.4 for PAPs in the first 2 weeks). Higher Breast-Q scores in the donor site domain were reported for PAP flaps compared to DIEP flap.
Conclusion
Given unbiased patient reported outcomes, we noted that the breast reconstruction journey after PAP flaps reconstruction seams to be lighter, quicker and more affordable compared to DIEP flaps in patients who experienced both of these types of reconstruction. Further studies are needed to evaluate these new findings and the psychosocial impact of each autologous breast reconstruction from a patient’s perspective.