Free deep inferior epigastric perforator flap after abdominal liposuction: reconsidering a contraindication

Abstract

Autologous breast reconstruction with perforators has been previously avoided in tissues that have undergone liposuction. We present a case series and literature review of breast reconstruction with deep inferior epigastric perforator (DIEP) flaps after abdominal wall liposuction. An MEDLINE search was performed for all relevant articles describing breast reconstruction with DIEP flap technique following the abdominal wall liposuction. Key search words used included “DIEP”, “DIEAP”, “deep inferior epigastric perforator”, “liposuction” and “free flap”. All published data on the topic from 1965 to December 2014 were reviewed. Articles were assessed for reports of clinical cases, complications, age, liposuction amount, time since liposuction and number of perforators for comparison. We have also presented 2 patients who underwent a DIEP procedure with a previous history of liposuction. Eight cases of autologous breast reconstruction using a DIEP flap after liposuction were identified in the literature in addition to the presented cases. The preoperative and postoperative course was uneventful in all cases except one patient who had a mild cellulitis managed with antibiotics and a second patient with a drainable hematoma. The average age was 52 years ± 6.4 years old, one perforator was used in all cases except one where 2 were used, and the average amount of total liposuction was 1,084 mL. No major complications were reported. Previous liposuction is not an absolute contraindication for free-flap breast reconstruction. Preoperative management should include evaluation of suitable perforators by duplex ultrasound or computed tomography angiography. Larger case series are needed to better understand the safety of perforator flaps after liposuction.

Keywords

Breast reconstruction / deep inferior epigastric perforator / flap / liposuction

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