A breast cancer diagnosis is traumatic enough, but the emotional toll of losing one or both breasts from a mastectomy can feel even more overwhelming. The good news is breast reconstruction surgery has made significant advances in the past couple of decades.
Many women are candidates for autologous reconstruction, a type of surgery that uses your own skin, fat, and sometimes muscleโknown as a โflapโโfrom your abdomen, back, or thighs to rebuild a more natural-looking breast.
Not only does this approach result in a more authentic appearance but also helps you avoid synthetic implants, which can sometimes require replacement or cause complications.
While the abdomen is often the first choice for a flap procedure, I also recommend two other proceduresโthe PAP flap and LTP flapโwhich are quickly becoming more common and even preferred by many women. So how do you know if either is an option for you?
What is PAP Flap and LTP Flap Reconstruction?
Both the PAP (profunda artery perforator) flap and LTP (lateral thigh perforator) flap are types of autologous breast reconstruction surgeries that use skin and tissue from your thighs to rebuild your breast.
Iโve been proud to be among only a handful of surgeons nationwide with experience performing the PAP flap procedure since it was developed, and Iโm encouraged by how many women have been able to take advantage of whatโs now a very common reconstruction option. In fact, the overall success rate of PAP flaps now ranges from 97% to 100% of patients!
PAP Flap Surgery
Using tissue from the back of the upper thigh, a surgeon takes tissue and its blood supply and transplants it to your chest to form a new breast. This option is good for women with small or medium-sized breasts. (If you have larger breasts, you may need a saline or silicone implant to match your larger size.)
LTP Flap Surgery
First introduced in 1990 and named for a blood vessel in the leg, the LTP flap option uses tissue from the upper outer thigh. And just like the PAP procedure, the surgeon removes the tissue and blood supply and uses it to rebuild a breast.
When are these procedures recommended?
These procedures are becoming popular options for women who arenโt good candidates for an abdominal flap surgery (including the DIEP, SIEA, or TRAM flaps)โpossibly because they donโt have enough available tissue, or if theyโve already undergone major abdominal surgeries in the past.
Both procedures are considered โmuscle-preserving proceduresโ because no muscle is removed, which typically means less pain for you. A number of factors may play into the decision of which surgery is best for your body and your ideal breast size and shape, so consult with your doctor to help you navigate that process.
What Should I Expect with a PAP/LTP Procedure?
The procedure for both PAP and LTP flaps is very similar:
- Your surgeon will make an incision, either in the back of your upper inner thigh (PAP) or the upper outer thigh (LTP).
- Skin, fat and blood vessels are removed from the area.
- Your surgeon will then use microsurgery techniques to connect the blood vessels in the flap to those in the chest to form a new breast.
- The surgery and reconstruction process will take approximately three to five hours.
- For a PAP flap, the incision is very close to the natural crease between your thigh and buttocks, so the scar from the incision is hidden for the most part. For a LTP flap, the scar can be seen along your outer thigh and may require fat grafting to correct a divot that sometimes appears.
Whatโs Recovery Like After a PAP Flap or LTP Flap?
After your procedure, youโll typically stay in the hospital for one to three days, and your recovery process at home will last about four weeks (potentially longer if both thighs were involved). Typically, I recommend patients wear a compression girdle over the upper thigh to reduce swelling. Remember to keep the incision areas clean and dry as you recover.

Whatโs my Next Step for Breast Reconstruction?
For women facing a mastectomy, autologous breast reconstruction can be a transformative experience to not only restore your natural appearance but also regain a sense of control during an especially challenging time. And studies have shown that not only can breast reconstruction โsignificantlyโ decrease the incidence of anxiety in women, but those who undergo an autologous reconstruction like a PAP or LTP flap are more satisfied and have a higher โbreast-related quality of lifeโ than those who choose the implant route.If youโre interested in learning more about PAP or LTP flap procedures, or if you want to explore other breast reconstruction options, please contact The Breslow Center online today or call us at (201) 444-9522 to schedule a consultation. Our entire team truly cares about your breast reconstruction journey and will take time to address all your concerns and questions.