{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:07:52Z","timestamp":1754161672485,"version":"3.41.2"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>While autologous breast reconstruction using the profunda femoris artery perforator (<jats:styled-content style=\"fixed-case\">PAP<\/jats:styled-content>) flap is becoming increasingly popular, no aesthetic evaluation has been reported. The aim of this study is to evaluate the reconstructed breast using the <jats:styled-content style=\"fixed-case\">PAP<\/jats:styled-content> flap quantitatively and to clarify which factors contribute to the aesthetically favorable results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified 127 patients who underwent breast reconstructions using the vertically designed <jats:styled-content style=\"fixed-case\">PAP<\/jats:styled-content> flap for unilateral breast cancer between April 2018 and December 2021. The <jats:styled-content style=\"fixed-case\">PAP<\/jats:styled-content> flap was elevated vertically to avoid disrupting lymphatic pathways and was inserted between the pectoralis major muscle and the subcutaneous fat after the anastomoses. We classified cases into two groups: the \u201cFavorable cosmesis group\u201d and the \u201cUnfavorable cosmesis group\u201d based on aesthetic evaluations using the vectra three\u2010dimensional (<jats:styled-content style=\"fixed-case\">3D<\/jats:styled-content>) imaging system. Patient characteristics and outcomes between two groups were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 127 patients, 15 were excluded: three with stacked <jats:styled-content style=\"fixed-case\">PAP<\/jats:styled-content> flaps, two with flap necrosis, and 10 with missing aesthetic outcome data. Among the remaining 112 patients, 18 were classified in the \u201cFavorable cosmesis group\u201d and 94 in the \u201cUnfavorable cosmesis group.\u201d Comparative analysis revealed that the \u201cFavorable cosmesis group\u201d showed significantly higher ratio with small volume in the upper pole of the unaffected side (21% vs. 72%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and had a smaller final inset flap weight (147 vs. 190\u2009g, <jats:italic>p<\/jats:italic>\u2009=\u20090.028) compared to the \u201cUnfavorable cosmesis group.\u201d All 112 patients were evaluated using vectra <jats:styled-content style=\"fixed-case\">3D<\/jats:styled-content> system at 12\u2009months postoperatively, and their postoperative flap courses were uneventful.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In our study, inherent small volume of the upper pole and smaller flap inset weight contribute to more favorable outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.70085","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T07:39:41Z","timestamp":1750750781000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Aesthetic Outcomes in Autologous Breast Reconstruction Using Profunda Femoris Artery Perforator Flap"],"prefix":"10.1002","volume":"45","author":[{"given":"Chika","family":"Gon","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo Japan"},{"name":"Department of Plastic and Reconstructive Surgery Nippon Medical School Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-8094","authenticated-orcid":false,"given":"Ryo","family":"Karakawa","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidehiko","family":"Yoshimatsu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuma","family":"Fuse","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rei","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Nippon Medical School Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyuki","family":"Yano","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182363d9f"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002619"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200106000-00013"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002166"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000003553"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1649508"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2015.03.011"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000619"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1727200"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2020.03.023"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-2040-1368"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31006"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-018-4843-6"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-022-03087-z"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001189"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000587"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30074"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2020.08.109"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjx227"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004728"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000002333"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58040458"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70085","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T07:04:10Z","timestamp":1753772650000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70085"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,24]]},"references-count":22,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/micr.70085"],"URL":"https:\/\/doi.org\/10.1002\/micr.70085","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"type":"print","value":"0738-1085"},{"type":"electronic","value":"1098-2752"}],"subject":[],"published":{"date-parts":[[2025,6,24]]},"assertion":[{"value":"2024-08-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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