Duke Plastic Surgery Completes Successful LAP Flap Bilateral Breast Reconstruction

By Jessica Bronchick, Duke Surgery

In March 2024, surgeons within the Duke Division of Plastic, Maxillofacial, and Oral Surgery completed a successful bilateral breast reconstruction surgery utilizing the Lumbar Artery Perforatory Flap (LAP Flap). This was the second time this procedure was performed at Duke after the patient's first side was completed in 2023.

The Duke team, co-led by Brett T. Phillips, MD, Assistant Professor of Surgery, and Geoffroy Sisk, MD, Assistant Professor of Surgery, were compelled to think outside of the box to offer this more challenging reconstruction option for a patient with prior breast cancer and radiation who was not a candidate for more common autologous options.

Dr. Brett Phillips
Brett T. Phillips, MD
Asisstant Professor of Surgery

"The LAP Flap is not a common reconstruction technique due to its technical challenges, and is only performed regularly at a few locations across the country," says Dr. Phillips.

The innovative technique involves removing skin and fat from the lumbar area of the patient's back, along with its blood supply, and transplanting it to the breast for breast reconstruction. 

The need for the LAP Flap arose out of a need for a suitable donor site in a patient whose slim body habitus made conventional options difficult. When patients do not have enough donor tissue in their abdomen or thighs—the most commonly used donor sites—to restore adequate volume to their breasts, newer and more innovative solutions need to be considered. 

"One of the great things about breast reconstruction in the modern age," says Dr. Sisk, "is that more surgical options than ever before, including numerous tissue-based options, are available for patients to choose from. More options means more patients are able to participate meaningfully in the decisions that shape their own care, which is a rare and empowering thing in the world of medicine."

Dr. Geoffroy Sisk
Geoffroy Sisk, MD
Assistant Professor of Surgery

Offering a procedure such as a LAP Flap, Dr. Phillips says, benefits both patients and physicians in being able to meet the needs of patients and improve the level of care provided.

"Duke is a national leader in reconstructive microsurgery and microsurgical education, and it's important that we are able to offer options that might not be available elsewhere," says Dr. Phillips. "This will improve patient referrals and recruitment with the overall goal of improving patient care nad hospital experience."

Learn more about Duke Plastic, Maxillofacial, and Oral Surgery.

Learn more about Duke Oncologic Reconstruction.