Deep Inferior Epigastric Perforator Flap for Breast Reconstruction after Cosmetic Procedures of the Abdomen

Breast reconstruction with the deep inferior epigastric artery perforator flap (DIEP) is generally accepted as the gold standard for reconstruction after mastectomy. However, with the increasing popularity of cosmetic procedures, an increasing number of patients with a history of a cosmetic procedure of the abdomen present for an autologous breast reconstruction with a DIEP flap. Experience with DIEP breast reconstructions in patients with previous abdominal cosmetic procedures was presented.

Between November 2002 and November 2004, seven patients with a history of cosmetic abdominal surgery presented for an autologous breast reconstruction with a DIEP flap. Two patients had a history of previous mini–abdominoplasty without transposition of the umbilicus, and five patients had undergone previous liposuction of the abdomen. All patients had a sufficient amount of abdominal tissue to consider a DIEP flap. Preoperative duplex sonography was used to evaluate number and quality of the perforators. Data were gathered retrospectively.

One patient with a previous mini–abdominoplasty underwent a bilateral reconstruction with one DIEP (one perforator) and one free muscle–sparing transverse rectus abdominis muscle (TRAM) flap. The second patient with previous abdominoplasty had a unilateral reconstruction with a DIEP flap based on one perforator. In the liposuction group, three patients had a DIEP reconstruction based on one perforator and two patients had a DIEP reconstruction based on two perforators. The internal mammary vessels were used as receptor vessels in 6 flaps and the thoracodorsal vessels in 1 flap. There was no evidence of fat necrosis, fibrosis, or any delayed wound healing. The patient with the bilateral reconstruction had a transient peroneal nerve deficit. The overall complication rate was therefore 14.2%. Cosmetic results did not differ from other DIEP flaps.

An autologous breast reconstruction with a DIEP flap can still be considered after a cosmetic procedure of the abdomen when sufficient tissue remains available. Preoperative evaluation of the perforators with duplex sonography was recommended.