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Fisher et al. Plast Aesthet Res 2024;11:36 https://dx.doi.org/10.20517/2347-9264.2024.53 Page 11 of 13

Figure 8. AV graft back table anastomosis. AV: Arteriovenous.

Figure 9. Bilateral LAP flap Reconstruction (mastectomies, reconstruction, and body transformation). LAP: Lumbar artery perforator.

contouring as the “love handle” tissue is converted into a breast [Figure 9]. Harvest of tissue from the lower
back and flank has the net effect of narrowing the patient’s waist, lifting her buttock, and accentuating the
feminine lower back curvature. While the LAP flap is an excellent option for breast reconstruction, most
surgeons generally do not consider these flaps as a “first-line” donor site if the abdomen has sufficient tissue
suitable for restorative breast surgery. This is generally because of the higher rate of complications and flap
loss associated with LAP flaps in comparison to DIEP flaps . In general, the LAP flap is associated with
[15]
more arterial complications than DIEP flap surgery. For this reason, we are meticulous with the
anastomosis of the graft to the artery. If the artery does not allow for coupling without fracture of the intima
layer, we handsew the anastomosis with 10-0 nylon. In addition to flap loss, significant donor site
complications include seroma, hematoma, changes in sensation including numbness in the lower back and
upper buttock, incision breakdown, and contour abnormalities. Seroma formation at the donor site has
been reported, as the lymphatics near the fascia overlying the paraspinal musculature can be disrupted