Long-term Evaluation of Quality of Life and Aesthetic Outcomes After Autologous Breast Reconstruction Using the Profunda Artery Perforator (PAP) Flap

Background

Autologous breast reconstruction is associated with improved patient satisfaction and quality of life after mastectomy. While the deep inferior epigastric perforator (DIEP) flap is considered the standard autologous reconstruction technique, the profunda artery perforator (PAP) flap has emerged as an effective alternative for patients lacking adequate abdominal donor tissue. Despite increasing use of the PAP flap, long-term evidence regarding patient-reported outcomes and objective aesthetic results remains limited.

Objective

The primary objective is to assess long-term quality of life after breast reconstruction using a PAP flap.

Secondary objectives include evaluation of aesthetic outcomes, donor-site morbidity, and correlations between objective and subjective measures of reconstructive success.

Study Design

This is a single-center, observational, non-interventional study conducted at the Department of Plastic Surgery, European Georges Pompidou Hospital (Paris, France).

Women who underwent unilateral or bilateral breast reconstruction using a PAP flap between 2014 and 2024 will be contacted and invited to participate.

Outcome Assessment Primary Outcome

Quality of life will be assessed using validated patient-reported outcome measures:

BREAST-Q Reconstruction Module (French version) PROMIS-29 Profile (French version)

Assessments will be performed at least two years after reconstruction.

Secondary Outcomes

Aesthetic outcomes will be evaluated through a multimodal approach including:

Standardized clinical photographs Objective photographic analysis using BCCT.core software Volumetric and symmetry assessment when available Blinded evaluation by a panel of plastic surgeons and lay reviewers

Additional analyses will explore the relationship between objective aesthetic measurements and patient-reported satisfaction.

Study Population

Approximately 264 women who underwent PAP flap breast reconstruction between 2014 and 2024 at the European Georges Pompidou Hospital will be eligible.

Significance

The study will provide valuable long-term data regarding quality of life, patient satisfaction, aesthetic outcomes, and donor-site sequelae after PAP flap breast reconstruction. These findings may improve patient counseling and optimize reconstructive decision-making for women undergoing breast cancer treatment.

Inclusion criteria

• Female patients aged 18 years or older.
• History of unilateral or bilateral breast reconstruction using a profunda artery perforator (PAP) flap.
• Breast reconstruction performed between 2014 and 2024 at the European Georges Pompidou Hospital.
• Able to understand study procedures and complete study questionnaires.
• Provided non-opposition/consent to participate according to French regulations.

Exclusion criteria

• Patients younger than 18 years.
• Breast reconstruction performed using techniques other than PAP flap.
• Breast reconstruction performed outside the study period (2014-2024).
• Patients under legal protection measures.
• Severe cognitive impairment or major psychiatric disorder preventing questionnaire completion.
• Hearing impairment preventing participation in the interview process.
• Insufficient French language proficiency.
• Missing essential clinical data.
• Explicit refusal to participate.