Anyone out there with a LAP (Lumbar Artery Perforator) Flap?

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buttonsmachine
buttonsmachine Member Posts: 930
edited May 2018 in Breast Reconstruction

Hi All,

I have searched the boards and BCO and I can't find ANY info on the LAP (lumbar artery perforator) flap. This surgery is a muscle sparing autologous reconstruction option that uses the "love handles" or "muffin top" when abdominal donor site reconstruction (such as DIEP) is not an option.

My understanding is that the LAP flap might be preferable to SGAP because it does not risk deforming the buttock. Also, it is preferable to a TUG flap in the sense that it's not a weight bearing area. So why isn't this done more frequently?

Although not many surgeons do this, I know there are ladies out there who have had this type of reconstruction. If anyone can shed some light on this I'd really appreciate it!

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  • buttonsmachine
    buttonsmachine Member Posts: 930
    edited May 2018

    Anyone? :-)

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  • besa
    besa Member Posts: 1,088
    edited May 2018

    Sounds like you have done an impressive amount of research on this topic :-)

    This surgery is routinely done by the NOLA docs (Delacroce, Sullivan, Trehan, Blum) but is often referred to by woman as "hip" flaps ... or sometines just referred to as sGAP. There are or, have been in the past, numerous woman on these boards who have had this type of surgery.

    I initially hoped to have"hip" flap surgery at NOLA but during surgery it was found that my blood vessels ran in such a way that required a slightly lower donor site. No hip deformity in my case. I am happy with my outcome.

    If there are no other responses here and you are considering having this surgery done at NOLA there is a NOLA facebook group where you will find many woman who have had this type of surgery. If you are interested you will need someone already in the group to add you.

    My feeling- sGAP or hip flap surgery requires a ps (or better yet 2 experienced ps working together to cut down o.r. time) who are very experienced . At the time I looked onto this, the local DC metro area/ Baltimore ps were doing maybe 15 of these surgerirs/year and residents and fellows were participating in the surgery. The NOLA ps were doing multiple hundreds/ year and there were 2 very experienced senior ps participating in each reconstruction

    My understanding is that the NOLA docs do not do TUG surgery because of the problems associated with it.


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  • Lula73
    Lula73 Member Posts: 1,824
    edited May 2018

    yes, the NOLA docs do this. I think they consider it a modified SGAP. Keep in mind as well that most PSs that do SGAP don't do many of them (except NOLA) because they don't do a good job with them. Those same PSs often don't touch anything but the breasts after stage 1 hence so many SGAP patients with a buttock deformity. NOLA does do revisions in the harvest area as standard part of stage 2 to rectify any deformity that appears during healing phase. This is true for all of their Natural tissue reconstruction procedures. And they get insurance to cover it. Check out the NOLA website SGAP before & after photos. Those photos are the real deal. I'm living proof on the DIEP side of things. Keep in mind that the NOLA doc's work is not representative of what other docs' work looks like. Always insist on before and after photos of the surgeons work and if you would not be happy to have what you see in the photos for yourself (not just happy with it considering you've had a mx), keep looking for a PS who does have work you like.

    https://www.breastcenter.com/result-photos/sgap-photos/


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  • buttonsmachine
    buttonsmachine Member Posts: 930
    edited May 2018

    Thank you Besa and Lula for the detailed responses - you are both a wealth of information. :-) If my SGAP results turned out that well I'd be more than satisfied. It's reassuring to hear that you both had good experiences at NOLA.

    It makes sense that LAP flaps might be a modified SGAP - from what I read surgeons "discovered" the possibility of a LAP flap while doing SGAP surgeries.

    It seems like the LAP incisions are somewhat higher than standard SGAP incisions, but I like that they use the muffin top. (Thanks to cancer treatment I have some muffin top I never used to have, and I certainly wouldn't mind using it for my reconstruction!)

    I found one woman's experience to be helpful: http://www.joanlunden.com/category/35-breast-cancer/item/1205-i-breasted-my-surgical-success-turning-love-handles-into-love-ly-curves

    And in this article they show a good picture of the location of the donor site: (Also includes surgery photos, so don't look if you're queasy.) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878252/

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