Breast Reconstruction Pathways

Lumbar Artery Perforator (LAP) flap breast reconstruction is an advanced microsurgical technique that uses skin and fat from the lower back to rebuild the breast after mastectomy. It offers a natural look and feel — without sacrificing muscle — and can be an excellent option for women who are not candidates for abdominal-based flaps.

This procedure is especially helpful for those who are thin, have had prior abdominal surgery, or need an alternative donor site for autologous (your-own-tissue) reconstruction.

What is a LAP Flap?

A LAP flap uses tissue from the lumbar region of the lower back, just above the hips. The surgeon carefully removes skin and fat supplied by small perforator blood vessels and transfers the tissue to the chest, where the vessels are reconnected under a microscope.

Like other perforator flap procedures, the LAP flap:

• Uses skin and fat only — no muscle

• Preserves strength and mobility

• Creates a breast that looks, feels, and ages naturally

The donor area is closed in a way that often results in a hidden scar along the waistline.

Who May Benefit from a LAP Flap?

You may be a good candidate if you:

• Do not have enough abdominal tissue for a DIEP or SIEA flap

• Have had prior abdominal surgeries that limit flap options

• Are thin but carry more tissue in the lower back/hip area

• Prefer an autologous reconstruction instead of implants

• Need an alternative donor site after previous reconstruction

A consultation with a microsurgeon experienced in perforator flap techniques is essential to determine candidacy.

How the Procedure Works

1. Skin and fat are taken from the lower back

2. Blood vessels are carefully preserved

3. The tissue is transferred to the chest

4. Vessels are reconnected using microsurgery

5. The breast mound is shaped for natural contour

6. The donor site is closed along the waistline

The result is a soft, natural-feeling breast made entirely from your own tissue.

Benefits of LAP Flap Reconstruction

• Uses your own natural tissue

• No muscle removal, preserving strength

• Excellent option when the abdomen is not usable

• Creates a long-lasting, natural look and feel

• Avoids implants

• Can improve body contour at the donor site

Considerations to Keep in Mind

• Requires highly specialized microsurgical expertise

• Not available at all reconstruction centers

• Surgery time is typically longer than implant-based options

• Donor site is on the back, which may:

  • Limit lying flat briefly during early recovery

  • Require special attention to incision care

Recovery and Healing

Most patients stay in the hospital 3–5 days after surgery. Recovery includes:

• Gradual return to daily activities over 4–6 weeks

• Temporary tightness or soreness in the lower back

• Follow-up visits to monitor healing and circulation

• Possible future revision procedures for symmetry and refinement

Many women appreciate the LAP flap for offering a powerful alternative when other flap options aren’t available.

LAP Flap vs. Abdominal Flap Options

                                  DIEP/SIEA Flap           LAP Flap

Donor Site      Lower Abdomen.        Lower Back

Best For           Abdominal Tissue      Abdomen
                                 Available                           not an option

Muscle               No                                            No
Removal

Scar                      Bikini Line                        Waistline
Location

Breast Feel     Natural                               Natural

Implant               No                                           No
Needed

Is a LAP Flap Right for You?

The best reconstruction option depends on your:

• Body type

• Surgical history

• Personal goals

• Access to specialized care

A conversation with a board-certified plastic surgeon who performs microsurgical breast reconstruction can help you explore whether a LAP flap fits your path forward.