Salvage of a failed partial prosthetic breast reconstruction using a free deep inferior epigastric artery perforator (DIEP) flap

Tertiary breast reconstruction with free tissue transfers is the gold standard in managing recalcitrant complications of implant-based whole breast reconstructions (WBRs). Whilst the salvage of implant-based WBR with free tissue transfers is well established, there have hitherto been no reports of free flap use for salvaging failed or suboptimal partial prosthetic breast reconstructions. We report a case of delayed partial breast reconstruction after lumpectomy and axillary clearance, where a deep inferior epigastric artery perforator flap successfully salvaged a suboptimal thoracodorsal artery perforator flap (TDAP) with underlying peri-implant capsular contracture, avoiding the need for completion mastectomy. The challenges encountered were complicated by severe capsular contracture, chronic pain, poor cosmesis, prior tissue rearrangement, radiotherapy changes, residual breast tissue, and scarring from a previous TDAP flap. Microvascular autologous conversion, a standard treatment of failed prosthetic WBRs, also has the versatility to salvage complex partial reconstructive dilemmas accentuated by prior radiotherapy and the presence of residual potentially compromised breast tissue.

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This case report describes delayed partial breast reconstruction in which a free deep inferior epigastric artery perforator flap salvaged a suboptimal thoracodorsal artery perforator flap with peri-implant capsular contracture, avoiding completion mastectomy despite prior radiotherapy, scarring, and residual tissue.

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