In this report, I’d like to introduce two new ideas and concept of innervated Profunda artery perforator flap (iPAP flap) and combined SIEA and SCIP double pedicle flap (SaS flap) for breast reconstruction. Nowadays, the DIEP flap becomes the gold standard for breast reconstruction because the DIEP flap can provide ideal adipose tissue with adequate size and volume. But there are still some drawbacks and limitation of using the DIEP flap that is possible postoperative abdominal bulging and difficulty in breast reinnervation. To solve these problems and limitations, I started to use SaS flap and iPAP flap. A concept of SaS flap is simple, this flap contains two independent feeding vessels, SIEA and SICA, in the hemi-side of the flap. The SCIA system will augment the blood supply of the SIEA system, and which will enable the entire abdominal flap to have a vascular territory across the midline. On the other hand, we found that we can include a sensory nerve which is a branch of the obturator nerve to make the PAP flap as innervated flap. We introduce these techniques with ICG angiography and flap harvesting videos.

Materials and Methods
We reviewed six cases of SaS flap and 13 cases of iPAP flap for breast reconstruction. There are three different patterns of iPAP flap harvesting, type 1: a sensory nerve can find in subcutaneous tissue, type 2: a sensory nerve runs along with the medial femoral circumflex system and type 3: a sensory nerve runs along with PAP flap perforator vessels.

Results
There was no flap loss or severe postoperative complications in both SaS flap and iPAP flap. Average reconstructive time of SaS flap and iPAP flap were 7:40 and 5:15 respectively and average ischemic time of SaS flap and iPAP flap were 1:30 and 1:35 respectively. An average postoperative hospital stay of both techniques was the same eight days.
83% of SaS flap showed ICG fluorescence across the midline. Moreover, 33% of SaS flap showed ICG fluorescence in all zones. 83% of SaS flap had common trunk artery of the SIEA and SCIA and 33% of the SaS flap had a common trunk vein of the SIEV and SCIV.
Ten out of 13 patients, PAP flap could be harvested as an innervated PAP flap. But in three cases, there were no sensory nerves could be found around the PAP flap.

Conclusion
The SaS flap might resolve the problem of donor site morbidity and provide more reliable abdominal flap with only superficial feeding and drainage vessels. The iPAP flap might be another option to achieve sensate breast reconstruction with less donor site morbidity. We believe both the SaS flap and iPAP flap will provide patients with more satisfactory breast reconstruction.