Breast Reconstruction Pathways

The PAP flap (Profunda Artery Perforator flap) is a type of natural tissue breast reconstruction that uses skin and fat from the upper inner thigh to rebuild the breast. This technique is muscle-sparing—meaning no muscle is taken—so your thigh strength remains intact while still providing enough tissue for a soft, natural breast.

PAP flap reconstruction is especially helpful for women who don’t have enough abdominal tissue for options like the DIEP or TRAM flap, or for those who have had prior abdominal surgery.

How It Works

• A flap of skin, fat, and blood vessels is taken from the upper inner thigh, close to where the thigh meets the buttock.

• No muscle is removed—the procedure relies on fat and skin only.

• Using microsurgery, the surgeon reconnects the tiny blood vessels from the flap to vessels in the chest.

• The tissue is carefully shaped into a new breast mound.

• The donor site is closed, leaving a scar along the inner thigh crease, usually hidden under underwear or swimsuits.

Who May Be a Candidate

The PAP flap may be a good option if:

• You prefer natural tissue reconstruction over implants.

• You do not have enough abdominal tissue for reconstruction.

• You’ve had prior abdominal surgery that makes abdominal flaps less suitable.

• You have extra tissue on your upper inner thighs that can safely be used.

• You are healthy enough for microsurgery and longer surgery times.

Benefits of the PAP Flap

• Muscle-sparing: No thigh muscles are removed, preserving leg strength.

• Natural results: Breasts are soft, warm, and long-lasting.

• Hidden scar: Scar is placed along the inner thigh crease where it can be easily covered.

• Alternative donor site: Offers an option for women who can’t use abdominal or buttock tissue.

• Body contouring: Removes tissue from the inner thighs, similar to a thigh lift.

Things to Keep in Mind

• Complex surgery: Requires advanced microsurgery and may take several hours.

• Recovery: Expect soreness in both the chest and thighs; most women need 4–6 weeks before returning to full activity.

• Scarring: A scar will remain on the inner thigh crease.

• Volume limits: PAP flaps usually provide less tissue than abdominal flaps, so may not achieve larger breast sizes without additional fat grafting.

• Temporary discomfort: Sitting, walking, and certain movements may feel tight or sore during the early recovery phase.

Emotional Considerations

Many women feel reassured knowing they have a natural tissue option even if their abdomen isn’t suitable. The thigh scar is hidden, and the muscle-sparing approach means less concern about long-term weakness. At the same time, recovery from the inner thigh donor site can feel challenging in the first few weeks, which may feel frustrating. Both experiences are valid.

A Personal Choice

The PAP flap expands the options for women seeking natural tissue breast reconstruction. It uses tissue from the inner thighs—without sacrificing muscle—to naturally rebuild the breast and restore confidence. While it may not provide as much tissue as abdominal-based flaps, it can create beautiful, natural results with a hidden scar and preserved muscle strength.