Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy

Breast reconstruction continues to evolve on both the artistic and scientific fronts. The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard for breast reconstruction and results in patient satisfaction, aesthetically satisfactory outcomes, and favorable donor site morbidity [1]. For delayed reconstruction of the breast, a dual-pedicled DIEP flap is indicated to overcome insufficient hemi-abdominal tissue and extensive radiation effects on the chest wall [2]. The dual-pedicled DIEP flap provides a sufficient skin envelope and subcutaneous fat tissue for the creation of a natural-looking breast with adequate volume to match the contralateral breast [3]. The dual-pedicled DIEP flap requires microvascular augmentation, including turbocharging or supercharging; however, radiation therapy can damage candidate recipient vessels [4], resulting in uncertain patency that may lead to flap failure. Thus, the present report suggests a novel and effective surgical method, a dual-pedicled conjoined abdominal flap that uses a free DIEP flap combined with a pedicled transverse rectus abdominis muscle (TRAM) flap for volume-demanding, unilateral breast reconstruction, even in patients who have undergone radiotherapy. Jun Hyeok Kim, Na Rim Kim, Ye Sol Kim, Deuk Young Oh