Breast Reconstruction Using Combined Unilateral Hemiabdominal DIEP Flap with Lipofilling from the Contralateral Abdomen

Summary: The deep inferior epigastric perforator (DIEP) flap is the gold standard breast reconstruction procedure for patients with adequate lower abdominal tissue and is often elevated, including the unilateral DIEP. In patients with a lower midline abdominal surgical scar, the volume of the DIEP flap used for breast reconstruction may be limited because of the cessation of blood perfusion over the scar. Several options have been used for increasing the flap volume using bipedicled flaps; however, they are more invasive for the abdominal donor site and require longer operation time for complex vascular anastomoses. To overcome these disadvantages, we propose immediate breast reconstruction with simultaneous fat grafting combined with a DIEP flap, which can achieve an adequate breast volume. The patient was a 46-year-old woman with left-sided invasive ductal carcinoma. She underwent a left nipple-sparing mastectomy, sentinel lymph node biopsy, and one-stage immediate DIEP flap breast reconstruction. Indocyanine green angiography was used to evaluate the blood supply to the DIEP flap, and lipofilling was performed from the unstained flap area. The fat was injected into and under the pectoralis major muscle, and the total volume of the fat graft was 66 mL. The advantages of immediate lipofilling harvested from the unstained flap area include minimal sacrifice, the expectation of simultaneous restoration of the overall appearance of the breast with a minimal number of operations, the simplicity of the procedure, and the best use of viable tissues. Therefore, breast reconstruction combined with fat grafting is effective for volume augmentation.