Response to Mosaic Fleur-de-Profunda Artery Perforator Flap for Autologous Breast Reconstruction

Sir:

We are pleased to discover your new publication of Bourn et al¹ entitled “Mosaic Fleur-de-Profunda Artery Perforator Flap for Autologous Breast Reconstruction.” In this article, the authors reported a new design of the profunda artery perforator (PAP) flap technique for breast reconstruction including 2 cases. We congratulate the surgical team for the great outcomes reported and the well-written manuscript. On the other hand, we already described this surgical approach and published a case series of 17 patients recently.² In this series, we experienced that the trilobed fleur de-lys design provides an ideal shape to mold posterior thigh tissue into a natural breast with a satisfying result. Despite our 2 scar revisions with fat grafting, thigh scars were well concealed and did not affect the contour of the buttock, and all patients were satisfied with their reconstruction and donor site scars. We found regrettable to not be cited in this article. The fleur-de-lys skin paddle design not only allows an increase in the horizontal PAP flap volume but also increases the skin surface, with an acceptable donor site morbidity. For medium- or large-sized breasts, the fleur-de-lys PAP flap seems to be ideal when a deep inferior epigastric perforator (DIEP) flap-based reconstruction is contraindicated. Today, we perform this technique routinely with more than 60 cases done so far.