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Summary:. The profunda artery perforator (PAP) flap has become an alternative option for breast reconstruction. Reliable perforators arise through the adductor magnus muscle, and dissection of the perforator is straightforward. Recently, we have found that the PAP flap with the sensory nerves can be harvested as an innervated flap. We discuss the feasibility of PAP flap neurotization. We reviewed 13 patients for whom innervated PAP flap harvesting was considered. The average age was 50.7 years. There are 3 different patterns of innervated PAP flap harvesting, Type 1: including a sensory nerve that can be found in the adipose tissue around the PAP flap, Type 2: including a sensory nerve that runs along the medial femoral circumflex system, and Type 3: including a sensory nerve that runs along the profunda artery perforators. The average flap harvest time was 2:11 ± 0:31, and a sensory nerve was identified in 10 of 13 cases (77%). No sensory nerves were found in the other 3 cases. The length of the included sensory nerve was 5.5 ± 1.6 mm on average. Types 1 and 2 were found in 3 patients (30%), Type 3 was found in 2 patients (20%), and combined Types 1 and 3, 2 and 3 were found in one patient each (10%). As sensory nerves run around the PAP flap or close to the perforators, it is easy to perform flap neurotization with the PAP flap. We believe that the PAP flap could be an alternative option to achieve sensate breast reconstruction.

Summary:. A deep inferior epigastric perforator (DIEP) flap is one of the gold standards for autologous breast reconstructions. However, this flap cannot be chosen again if asynchronous contralateral breast cancer occurs in the future. To solve this problem, we propose an idea and design for a hemi-abdominal DIEP flap. The patient was a 50-year-old woman who was suffering from right invasive ductal carcinoma. In using a hemi-abdominal DIEP flap, the poor postoperative appearance of the donor site might be a problem. To obtain a good donor site shape, we use a specific design to make the appearance of the donor site as good as possible. Specifically, we make an oblique spindle-shaped flap that can cover the deep inferior epigastric perforators, the superficial circumflex iliac artery, and the superficial inferior epigastric artery and avoid dog-ears, without passing over the median line. The flap weight was 800 g, the operating time was 6 hours and 22 minutes, and the bleeding amount was 110 ml. The patient had a minor wound infection in the donor site, and it was treated with a local wound treatment. The patient is satisfied with the result. We believe our flap design could minimize the unfavorable appearance of the donor site. This method might be suited to cases where the patients present with excess skin and fat on the abdomen, and half the abdominal tissue is enough to create the necessary volume of the breast. Although more cases and studies will be required to justify our technique, this case may show the possibility of a new option for breast reconstructions.