Simultaneous bi-pedicled DIEP and TUG flaps to enhance cosmetic outcome in unilateral delayed breast reconstruction: two flaps with three pedicles for one breast

Abstract

Autologous breast reconstruction using free tissue transfer allows ‘like-for-like’ restoration of skin and volume following a mastectomy. Even though the majority of patients will require only one flap to restore their anatomy, occasionally, more than one flap is needed to get the best possible cosmetic outcome. For reconstructing the breast of a slim 49-year-old female patient, a bi-pedicled deep inferior epigastric perforator flap was used to replace the missing skin envelope, in combination with a buried transverse upper gracilis flap for volume restoration. The internal mammary vessels between the second and fourth costal cartilages were used as sole vessel recipient site, by preserving their intercostal perforators. Postoperative recovery was uneventful, and the patient was discharged 2 days after her operation. This case shows how a bi-pedicled DIEP with a TUG flap can be used for the challenging scenario in which reconstructive and cosmetic goals are equally important. Level of evidence: Level V, therapeutic study.