Superficial inferior epigastric artery-supercharged deep inferior epigastric artery perforator flap-based breast reconstruction for a thin patient: A case report

Although a bipedicled deep inferior epigastric artery perforator (DIEP) flap is widely accepted for slim patients with large breasts, we suggest DIEP flap-based breast reconstruction in which the superficial inferior epigastric artery (SIEA) is supercharged to the branch of thoracodorsal vessel as an alternative, which has not previously been well described. We report the case of a 48-year-old breast cancer patient who had a normal body mass index of 23.01 and relatively thin abdominal tissue, with large and ptotic (grade II ptosis) breasts. The mastectomy specimen weighed ~890 g, and the harvested abdominal tissue weighed ~700 g with a size of 32 × 12 cm². The elliptical-shaped flap was inset with a 90° counterclockwise rotation, and the lower one-third of the flap was folded to create a projection. Perfusion of flap was augmented by microvascular anastomosis between the contralateral SIEA and the serratus branch of a thoracodorsal vessel. With a supercharged DIEP flap, nearly the whole lower abdominal tissue (696 g, 99.4% of the elevated flap) could be transferred to obtain a symmetric contour, and there were no complications such as vascular obstruction, flap necrosis, and delayed wound healing during the postoperative course. Using the SIEA pedicle for contralateral abdominal perfusion with elongated branch of the thoracodorsal vessel, aesthetic inset and contouring of the reconstructed breast could be technically enhanced. The DIEP flap with the contralateral SIEA supercharged to the serratus branch of thoracodorsal vessel may be a feasible option for large ptotic breast reconstruction in thin patients.