Hi Outdoorsy, just wondering if you had your surgery? How did it go?

My recon options are similar to yours, although it'll be a while before I can reconstruct.

For those still evaluating PAP vs. SGAP, I have not had either (yet), but may be doing the PAP soon. I had the DIEP performed first, following a single Mx. Fast-forward to a later time where I am evaluating options for my native side (to achieve symmetry), and following the success of the DIEP, I now find myself wanting to do autologous reconstruction again. My PS, a top breast reconstruction surgeon in Houston, whom I completely trust at this juncture, recommends the PAP over the SGAP, but he may do the PAP a little differently than how others might. Instead of a horizontal cut that is hidden in the folds below your buttocks, he does a vertical cut that starts in your inner thigh by curves around to the back of your leg. This means that you do end up with a scar that is visible in bathing suits (but hopefully diminished over time to a faint white line....I've seen "after" pics that are promising in this regard, and also talked with a patient who is 1-year post-PAP and has no regrets). However, you also end up with thinner thighs (not just less thigh on the backside), and everyone loves thinner thighs, right? (I'm not so interested in a flatter bottom as would be achieved with the SGAP, but there are others who might like a flat tushie).

The other benefit to this vertical method -- as I understand it, but am open to others correcting me -- is that it allows the PS to cut the optimal way across the grain, avoids cutting through the PFC nerve, and avoids cutting a prime weight-bearing area (right below and supporting your buttocks). I know Dr. Dellacose at NOLA does not like the PAP, and it seems from his video that mentions why he does not like the PAP, it's because of these issues. So because a lot of people on this forum may see that video and end up running away from the PAP (since the video has been posted on this forum multiple times, with the implied warning to avoid the PAP), I just want to put out there that there are other expert breast reconstruction surgeons that do a lot of PAPs and love them, and they may offer a variation to the traditional PAP that avoids the issues that Dr. Dellacose has raised. If you're near Houston, I can send you a recommendation.

I will keep this community updated if I end up doing the PAP (my other choice at this point is an implant). For now, I just wanted to share what I've learned about the PAP and let others know that there are PAP variations to the traditional one.

Ultimately, I would say that breast reconstruction is not a "one-size-fits-all" situation, and each person needs to find the procedure (and the surgeon) that is right for them.