Deep Inferior Epigastric Artery Perforator (DIEaP) Flap Harvest After Full Abdominoplasty

The deep inferior epigastric artery perforator (DIEaP) flap represents the gold standard for autologous breast reconstruction. Due to the preoperative computed tomography angiography (CTA), previous abdominal surgeries are no longer contra-indication for DIEaP flap harvesting; however, previous abdominoplasty with umbilical transposition is still considered an absolute contra-indication for a DIEaP-flap. This case reports a DIEaP flap-based breast reconstruction in a patient who had undergone a full abdominoplasty 10 years before and, taking this into account, the patient was planned for a lumbar artery perforator (LaP) flap reconstruction. Surprisingly the preoperative CTA mapping identified a good caliber DIEa perforator in the peri-umbilical region on the right hemiabdomen. A classical flap harvest and one arterial and one venous anastomosis to the internal mammary vessels were performed. However, due to venous congestion, the flap was revised twice: the first time intra-operatively and the second time 12 h postoperatively. The flap fully recovered and the patient was discharged at day 8 postoperatively. The flap edges showed some superficial necrosis that was treated with conservative treatment, while the donor site healed uneventfully. The patient underwent secondary aesthetic procedures 4 months later.