Breast Reconstruction With Low-Design Bilateral Conjoined Superficial Inferior Epigastric Artery Flap due to Abdominal Mercedes-Benz Incision Scar: A Case Report

Abstract

Breast reconstruction using an abdominal flap in patients with scarring on the upper abdomen is challenging. We present herein a new approach to two-stage breast reconstruction using a low-design bilateral conjoined superficial inferior epigastric artery (SIEA) flap in a 48-year-old woman with breast cancer and a Mercedes-Benz abdominal scar. The 30 × 8 cm² abdominal flap was designed more inferior than the conventional deep inferior epigastric artery perforator (DIEP) flap, excluding the umbilicus and widening the width between the transverse scar of the Mercedes-Benz incision and the cephalad incision line of the flap. This modification preserved the paraumbilical DIEPs within the upper abdominal skin of the donor site while the abdominal flap was harvested with the bilateral superficial inferior epigastric arteries as the main vascular pedicles. The left and right vascular pedicles were then anastomosed to the proximal and distal ends of the internal mammary vessels, respectively. The flap survived completely after surgery and the donor site healed without any major complications. 6 months after surgery, the reconstructed breast was slightly smaller than its counterpart, although it maintained good shape. The low-flap design in this case contributed to the prevention of donor-site complications, and the use of a bilateral conjoined SIEA flap allowed for the transfer of the entire abdominal pannus without compromising the strength of the abdominal wall. The case reported herein shows that this technique can be a viable reconstructive option for patients with a history of scarring on the upper abdomen.