Week 3 - Pooja Nair

Name: Pooja Nair

Clinical Mentor: Dr. Jason Spector

This week, I wanted to highlight a DIEP flap case performed for a patient with atypical hyperplasia undergoing bilateral breast reconstruction. The patient underwent a bilateral mastectomy followed by immediate reconstruction using an abdominal‑based perforator flap, the Deep Inferior Epigastric Perforator (DIEP) flap. In this approach, the deep inferior epigastric artery and vein supply blood to the lower abdominal skin and fat that form the flap.

During a mastectomy, the breast gland is removed; in a DIEP reconstruction, vascularized abdominal tissue replaces that lost volume. Because this was a bilateral mastectomy, tissue from each side of the abdomen was used to reconstruct both breasts.

The DIEP flap consists of skin and fat nourished by perforating vessels that pass through the rectus muscle. The surgeons dissected these perforators free while preserving the rectus muscle and fascia. Once isolated, the flap containing lower abdominal skin, fat, and its vascular pedicle was transferred to the chest.

After transfer, the flap’s artery and vein were connected to recipient vessels using microsurgical anastomosis. Under magnification, we watched on the OR screen as the surgeons performed the arterial and venous connections to restore blood flow. As an added benefit, the donor‑site closure provides a cosmetic effect of a “free tummy tuck.”

During postoperative rounds, we assessed flap perfusion, an essential step to ensure the microsurgical connections remain patent and the transferred tissue stays viable. Once stable perfusion is confirmed, the remaining skin paddle will be trimmed and incorporated into the final breast contour during a follow‑up procedure.1,2

 

References

1.      Aziz, M. Ben & Rose, J. Breast Reconstruction Perforator Flaps. Treasure Island (FL): StatPearls https://www.ncbi.nlm.nih.gov/books/NBK565866/ (2023).

2.      DIEP Flap in Austin | Austin Plastic & Reconstructive Surgery. https://www.austinplasticandreconstructivesurgery.com/reconstructive-plastic-surgery/breast-reconstruction/diep-flap/.

 

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