Easy venous superdrainage in DIEP flap breast reconstruction through the intercostal branch

The deep inferior epigastric perforator (DIEP) flap has been shown to be a valid option for breast reconstruction, as it has certain advantages over the free TRAM flap, including lower morbidity in the donor area, conservation of abdominal wall function, and reduced postoperative pain. However, some cases of venous congestion in using the DIEP flap have been described. The authors present a case in which the venous return in a DIEP flap objectively (by measurement with a flux meter) presented a marked improvement (from 4 ml/min to 13.9 ml/min) after venous drainage was increased by means of the supplementary anastomosis of a comitant vein from the deep inferior epigastric pedicle to the intercostal branch of the internal mammary vein. The preservation of this branch is a simple and effective technique to improve the venous drainage of DIEP flaps, whether signs of congestion are present or not.