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of breast reconstruction with DIEP flap after abdominal abdominal liposuction was performed 5 years before
wall liposuction will be demonstrated in addition to a the original diagnosis of breast cancer. Three years after
literature review. the mastectomy, the patient underwent autologous breast
reconstruction with a DIEP flap. The patient was
METHODS evaluated preoperatively for suitable perforators by
computed tomography (CT) angiography and duplex
An MEDLINE search was performed for all relevant ultrasound. Examination revealed appropriate perforator
articles describing the breast reconstruction with DIEP vessels and extensive fibrosis throughout the subcutaneous
flap technique following abdominal wall liposuction. This tissue caused by the previous liposuction. The patient
study includes all published data on the topic from 1965 underwent delayed unilateral breast reconstruction with a
to December 2014. The PubMed database of the National free DIEP flap. The postoperative course was complicated
Center for Biotechnology Information, National Library of by a mild cellulitis that was successfully treated with
Medicine (Bethesda, Maryland, USA), was used to collect antibiotics and no damage resulted to the flap [Figure 1].
reports using the keywords “DIEP”, “DIEAP”, “deep inferior Case 2
epigastric perforator”, “liposuction” and “free flap”. All A 59‑year‑old, smoker, female with breast cancer
articles were reviewed for reports of clinical cases including underwent a right mastectomy in 1998 followed by
complications, age, liposuction amount, time since implant‑based reconstruction the same year. She later
liposuction and the number of perforators for comparison.
underwent radiation therapy and subsequently developed
severe capsular contracture [Figure 2]. In 2012, she
RESULTS underwent right breast capsulectomy and reconstruction
with DIEP flap. Eighteen years earlier, the patient had
A total of 8 cases of autologous breast reconstruction undergone conventional abdominal liposuction. The
using a DIEP flap after liposuction were identified in patient was evaluated preoperatively for suitable
the literature review in addition to the 2 cases we perforators by CT angiography and duplex ultrasound.
present here. A study by De Frene et al. describes five Examination revealed appropriate perforator vessels.
[7]
[1]
consecutive cases, and Jandali et al. reports one case. Three days following the DIEP flap procedure the patient
In addition, Farid et al. reported 2 cases involving DIEP developed a hematoma that was evacuated and the
[8]
flap breast reconstruction after multiple liposuction patient had a stable postoperative course without any
procedures. The results of these studies including our flap compromise.
cases are summarized in Table 1. The preoperative and
postoperative course for all prior liposuction cases was DISCUSSION
uneventful except for our 2 patients: one who had a mild
cellulitis that resolved with appropriate therapy without Previous literature suggests that harvesting perforator
any compromise of the flap and another who experienced flaps from liposuctioned donor sites may not necessarily be
a hematoma which was subsequently drained. The [5,7]
average patient age was 52.2 years ± 6.4 years old, and a contraindication to free‑flap breast reconstruction. The
one perforator was used in all cases except one report largest reported series of DIEP flaps after liposuction was
[7]
where two were used. Of the reported cases, the average published by De Frene et al. with five successful cases
amount of liposuction collected was 1,084 mL. Two minor of breast reconstruction. The DIEP flap, introduced by
[9]
[10]
complications out of the total 10 cases were a mild Itoh and Arai and Koshima and Soeda and popularized
[12]
[11]
cellulitis and a postoperative stable hematoma. No major by Allen and Treece, Blondeel and Boeckx, and
[13]
complications were reported. Blondeel has been described as the most appropriate
way to reconstruct a breast to minimize donor
Case 1 morbidity. [6,14,15] The effect of liposuction on a free flap
A 50‑year‑old, nonsmoker, female underwent a left sided donor site months or years before flap transfer remains
mastectomy for invasive ductal carcinoma. Conventional to be clarified.
Table 1: Summary of studies performing DIEP reconstruction in patients who have had previous liposuction
Study Age Number of perforators Liposuction (mL) Years after liposuction Complications
Jandali et al. [1] 42 2 Not reported 9 None
Farid et al. [8] 57 1 240 + 300 + 300 1.33 None
54 1 100 to 160 × 5 0.5 None
De Frene et al. [7] 52 1 1,300 4 None
58 1 1,000 11 None
41 1 1,100 9 None
52 1 1,500 6.5 None
57 1 1,200 4 None
Our study 50 1 Not reported 5 Mild cellulitis
59 2 Not reported 18 Hematoma
DIEP: Deep inferior epigastric perforator
312 Plast Aesthet Res || Vol 2 || Issue 6 || Nov 12, 2015