Lumbar Artery Perforator Flap (LAP) is flap composed of fatty tissue and skin harvested from the lower back also commonly known as the “love handle” or muffin top regions. The lower back for most of both women and men is often where we carry thick fatty tissue. Also, the fat in this region is often thicker but still soft which allows it to mold and form into a shape that is like a breast implant. This makes the lower back an ideal location to harvest the flap for breast reconstruction.
The LAP flap blood supply also known as the pedicle, is small and short compared to other popular flaps such as the DIEP flap. Because of its small blood vessel and short pedicle, we often lengthen and enlarge its pedicle with a vascular graft. Our vascular graft of choice is harvested from either the lateral chest (thoracodorsal pedicle) or the groin (DIEP pedicle).
The LAP flap has grown in popularity in recent years due to the intrinsic flap properties listed above (thick and soft fatty tissue) and donor site contour. Patient has a well-hidden lower back scar and an improve contour of the lower back and buttocks as well as abdomen. Only a few microsurgeries center around the world are offering this reconstructive technique for breast reconstructions. At Goldberg Plastic Surgery, we have been offering the Lumbar artery perforator flap to our patients. It has become our second flap of choice in autologous breast reconstruction.
Patients who are the best candidate for Lumbar artery perforator flap (LAP) are
A breast reconstruction revision with a lumbar artery perforator flap normally takes anywhere from 5 hour/ breast to 7 hours /breast. A woman undergoing bilateral breast reconstruction with the LAP flap normally takes about 10 to 14 hours. It is usually slightly longer than a typical DIEP flap reconstruction due to both repositioning a patient during surgery and the additional micro surgery required to lengthen the pedicle of the flap. The length of the surgery does not mean that it is dangerous. The surgery is very safe. The pain level for this procedure is much less compare to the DIEP flap surgery.
The recovery after a lumbar artery perforator flap is relatively pain free. The patient will stay in the hospital usually for 3 to 4 days for flap monitoring. You can walk immediately after the surgery. You will feel tightness in the lower back over the buttock. The pain level is low compare to patients undergoing DIEP flap reconstructions. You will have usually anywhere from 4 to 6 drains. The 2 drains in each vascular graft site can come out before discharge from the hospital. The drains in each breast will stay in for one week. The drains in the lower back will usually stay in for 2 to 3 weeks to prevent seroma formation (fluid collection). The patient is refrained from heavy lifting for 4 weeks. The patient can return back to work after 4 weeks.
The lumbar tery perforator free flap is an excellent alternative in autologous breast reconstruction for those patients who are not eligible for the DIEP flap. The recovery is faster. The donor site scar is well hidden below the waistline. Furthermore, the patient will have an improve contour to the lower back, buttocks and abdomen.
Dr. Goldberg is a breasts reconstructive plastic surgeon in Beverly Hills, California specializing in the Lumbar Artery perforator Flap and other state-of-the-art breast reconstruction procedures. Our office will work with different insurance plan for our patients across and outside the US. Please call 310-325-0310 to learn more about your breast reconstruction options.