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Case Reports
. 2014 Dec 30:14:e47.
eCollection 2014.

DIEP breast reconstruction following multiple abdominal liposuction procedures

Mohammed Farid  1 , Simon Nicholson  1 , Ashutosh Kotwal  1 , Augustine Akali  1
Affiliations
Case Reports

DIEP breast reconstruction following multiple abdominal liposuction procedures

Mohammed Farid et al. Eplasty. .

Abstract

Objective: Previous abdominal wall surgery is viewed as a contraindication to abdominal free tissue transfer. We present two patients who underwent multiple abdominal liposuction procedures, followed by successful free deep inferior epigastric artery perforator flap. We review the literature pertaining to reliability of abdominal free flaps in those with previous abdominal surgery.

Methods: Review of case notes and radiological investigations of two patients, and a PubMed search using the terms "DIEP", "deep inferior epigastric", "TRAM", "transverse rectus abdominis", "perforator" and "laparotomy", "abdominal wall", "liposuction", "liposculpture", "fat graft", "pfannenstiel", with subsequent appraisal of relevant papers by the first and second authors.

Results: Patient 1 had 3 episodes of liposuction from the abdomen for fat grafting to a reconstructed breast. Subsequent revision reconstruction of the same breast with DIEP flap was preceded by CT angiography, which demonstrated normal perforator anatomy. The reconstruction healed well with no ischaemic complications. Patient 2 had 5 liposuction procedures from the abdomen to graft fat to a wide local excision defect. Recurrence of cancer led to mastectomy and immediate reconstruction with free DIEP flap. Preoperative MR angiography demonstrated a large perforator right of the umbilicus, with which the intraoperative findings were consistent. The patient had an uneventful recovery and good healing with no fat necrosis or wound dehiscence.

Conclusions: We demonstrate that DIEP flaps can safely be raised without perfusion-related complications following multiple liposuction procedures to the abdomen. The safe interval between procedures is difficult to quantify, but we demonstrate successful free flap after 16 months.

Keywords: DIEP; angiography; breast reconstruction; free flap; liposuction.

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Figures

Figure 1
Figure 1
Case 1 - Appearance of previously reconstructed right breast before revision reconstruction with DIEP flap.
Figure 2
Figure 2
Case 1 - Left sided perforator vessel supplying overlying skin and fat (arrow) on CT angiogram.
Figure 3
Figure 3
Case 1 - Appearance 5 months following DIEP flap breast reconstruction
Figure 4
Figure 4
Case 2 - MR angiogram demonstrating a single large patent perforator below and right of the umbilicus (arrow).
Figure 5
Figure 5
Case 2 - Appearance 1 week following DIEP flap breast reconstruction.
See this image and copyright information in PMC

References

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    1. May JW, Jr., Silverman RP, Kaufman JA. Flap perfusion mapping: TRAM flap after abdominal suction-assisted lipectomy. Plast Reconstr Surg. 1999;104(7):2278–81. - PubMed
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