When I learned about the options for breast reconstruction post-mastectomy, I immediately knew I wanted natural tissue reconstruction because I did not want an implant, and the complications that may come with an implant (i.e., capsular contracture, recalls, flips, leaks, etc.).
However, my reconstructive surgeon told me I was not a candidate for natural tissue reconstruction because of my weight; I was too thin. I accepted that as my fate and prepared for an implant. I had an expander put in at the time of my single mastectomy. For several weeks I went in to get 50cc of saline water injected into the expander.
By serendipity, I attended a breast cancer conference a few months after my mastectomy. There I met a specialist in perforator flap breast reconstruction. After a consultation, she confirmed I was a candidate for a PAP flap.
The PAP flap can be an option for thin patients wanting natural tissue breast reconstruction. This experience taught me that if I really want to do something and it feels right for my body, I should get a second opinion from someone who does the procedure.
We have to be our own advocates during our medical journey.
The PAP flap took me 10 months and five surgeries (normally it’s only three surgeries, I had two unplanned surgeries). There’s a three month healing period between each round of surgeries. This procedure is so rare, I did not meet anyone who had this type of surgery until one and a half years after my initial reconstruction surgery!
Because the PAP flap takes tissue and fat from the upper and inner thighs to rebuild the breast(s), incisions are made right below the buttocks and curve into the inner thighs. This means the patient cannot bend over for weeks while these incisions heal.
As a young, active yogi, this was a big change in my lifestyle.
It took me well over a month before I could bend over and tie my shoes. My yoga practice at this time shifted from doing physical poses (asanas) to more meditation and breathwork because I could not bend over. I wondered if and when my body would be able to do yoga-like I did before reconstruction. The fact is, I am two and a half years out from my first reconstructive surgery, and the muscles in my legs are still tight.
When I look at my breasts in the mirror I sometimes think, “Wow, all of that for a little asymmetrical breast!”
The trade-off for getting this type of natural tissue reconstruction is I now have a new set of scars right below my butt that are visible when I wear a bathing suit or short shorts. Tissue taken from both legs was stacked in my right breast.
My reconstructed breast has experienced a lot of fat necrosis.
My breasts are very asymmetrical, but would I do the whole process over again? I think yes.
My reconstructed breast is soft, warm, and looks natural (from the top). It is not painful nor does it require any maintenance. I am a young, very active, thin patient, and the PAP flap was the way I could do natural tissue reconstruction, which was the choice I wanted for my body.
Because this is such a rare type of reconstruction, I want to help share information on the PAP flap and make sure women are aware of it as a potential option, especially for those who have been told they’re too thin for natural tissue reconstruction.
