Lumbar Artery Perforator Flap

For women who want a natural breast after a mastectomy and who do not have sufficient abdominal tissue for a DIEP flap, the lumbar artery perforator flap procedure, also known as LAP, can be an alternative.

Using soft tissue from the lower back and flank — the “love handle” area — our microsurgeons reconstruct the breast entirely with your own living tissue, without sacrificing any muscle. The result is a naturally soft breast, a sculpted waistline and a lifted contour of the upper buttocks.

Because the LAP flap requires a highly specialized skill set, it is offered at only a small number of dedicated microsurgical centers globally. Our team performs more than 650 microsurgical procedures annually, making Orlando Health the most experienced microsurgery program in Florida — and the only program in the state performing this procedure. You can feel comfortable knowing our experienced teams work in a dedicated environment, supported by specialized nursing, anesthesia and postoperative monitoring protocols built around complex flap surgery.

Is This Procedure Right for You?

The LAP flap may be the right choice if you:

Prefer reconstruction with your own tissue rather than implants
Do not have enough excess abdominal tissue for a DIEP flap
Have had prior abdominal surgery, including a tummy tuck, which rules out belly-based flaps
Are seeking reconstruction of one or both breasts, at the time of mastectomy or as a delayed procedure

This procedure may not be appropriate if you are an active smoker, have poorly controlled diabetes or have significant cardiovascular disease. A thorough consultation with your surgeon is the best way to determine whether the LAP flap will work for you. We encourage you to schedule an appointment to discuss whether the LAP flap is right for you.

Benefits

Natural look and feel

Your reconstructed breasts are composed entirely of living tissue, providing a softness and warmth that implants cannot replicate.

Natural look and feel

Your reconstructed breasts are composed entirely of living tissue, providing a softness and warmth that implants cannot replicate.

Muscle-sparing technique

Your muscles will not be cut or moved. As a result, your pain level post-surgery will be relatively low and allows a faster return to normal activity. Most patients can control discomfort with over-the-counter products instead of narcotics.

Muscle-sparing technique

Your muscles will not be cut or moved. As a result, your pain level post-surgery will be relatively low and allows a faster return to normal activity. Most patients can control discomfort with over-the-counter products instead of narcotics.

Body contouring benefit

By using tissue from your “love handle” region along with the upper buttocks, you will gain a tailored waist and uplifted rear, which is an added aesthetic benefit unique to this donor site.

Body contouring benefit

By using tissue from your “love handle” region along with the upper buttocks, you will gain a tailored waist and uplifted rear, which is an added aesthetic benefit unique to this donor site.

Potential breast sensation

In selected cases, sensory nerves can be connected at the time of reconstruction, allowing the possibility of restored breast sensation over time, something implants cannot offer.

Potential breast sensation

In selected cases, sensory nerves can be connected at the time of reconstruction, allowing the possibility of restored breast sensation over time, something implants cannot offer.

Long-term durability

Once healed, the reconstructed breast requires no ongoing maintenance, device replacements or implant-related monitoring. It ages naturally with your body.

Long-term durability

Once healed, the reconstructed breast requires no ongoing maintenance, device replacements or implant-related monitoring. It ages naturally with your body.

Symmetry procedures available

If only one breast is reconstructed, your surgeon can perform a balancing procedure on the opposite side so both breasts — and both flanks — are matched in size and shape.

Symmetry procedures available

If only one breast is reconstructed, your surgeon can perform a balancing procedure on the opposite side so both breasts — and both flanks — are matched in size and shape.

Risks

As with all major microsurgical procedures, the LAP flap carries inherent risks, including bleeding, infection, wound-healing complications and the rare possibility of partial or complete flap loss. The surgery is technically demanding and requires a team with specialized microsurgical expertise, which is why it is available at only a limited number of centers. Our team will discuss your individual risk profile in detail during your consultation and will work to optimize your health prior to surgery.

What To Expect?

Before surgery

Your care team will conduct a thorough preoperative evaluation, which may include imaging to map the blood vessels of your lower back. Nutritional, psychological and social support services are available throughout your journey.

During surgery

The procedure is performed under general anesthesia and typically takes between five and 10 hours, depending on whether one or both breasts are being reconstructed. Using microscopic techniques, your surgeon carefully transfers tissue from your lower back to your chest, connecting small blood vessels to restore circulation to the new breast.

After surgery

Most patients remain in the hospital for three to four nights for close monitoring of the flap. You will be discharged with detailed recovery instructions. Small drains placed at the donor and recipient sites are typically removed within two to four weeks. Most patients return to light daily activities within four to six weeks and feel fully recovered within three to six months. Scars at the lower back donor site are typically concealable under underwear and swimwear. Secondary outpatient procedures to reconstruct the nipple-areola complex or refine symmetry can be performed once healing is complete.

Request an Appointment

If you'd like more information about this procedure, please schedule an appointment with one of our providers.

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