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Review Article Plastic and Aesthetic Research

Free deep inferior epigastric perforator flap

after abdominal liposuction: reconsidering

a contraindication

Peter James Mankowski, Jonathan Kanevsky, Anne-Sophie Lessard, Teanoosh Zadeh
Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec H3G 1B3, Canada.
Address for correspondence: Mr. Peter James Mankowski, Division of Plastic and Reconstructive Surgery, McGill University Health Centre,
Montreal, Quebec H3G 1B3, Canada. E-mail: peter.mankowski@mail.mcgill.ca

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.

Key words:
Breast reconstruction, deep inferior epigastric perforator, flap, liposuction

INTRODUCTION demonstrated successful breast reconstruction with a
transverse rectus abdominis myocutaneous flap after
Over the past decade, there has been an increase in liposuction; however, there is a paucity of data on
breast reconstruction among women who have previously breast reconstruction using a deep inferior epigastric
[1]
had liposuction. Raising a perforator flap is generally perforator (DIEP) flap after liposuction. [3‑6] Our experience
contraindicated after abdominal liposuction due to
possible damage of the perforators that supply the This is an open access article distributed under the terms of the Creative Commons
[2]
flap’s vascularity. Numerous articles have already Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix,
tweak, and build upon the work non-commercially, as long as the author is credited
and the new creations are licensed under the identical terms.
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How to cite this article: Mankowski PJ, Kanevsky J, Lessard AS,
Zadeh T. Free deep inferior epigastric perforator flap after abdominal
liposuction: reconsidering a contraindication. Plast Aesthet Res
DOI: 2015;2:311-4.
10.4103/2347-9264.169504
Received: 19-07-2015; Accepted: 29-09-2015
© 2015 Plastic and Aesthetic Research | Published by Wolters Kluwer ‑ Medknow 311