The Maylard incision: a low transverse incision variant seen in DIEP flap breast reconstruction

A low transverse abdominal incision, most commonly the Pfannenstiel incision, is often used in obstetric and gynecologic surgery. The Maylard low transverse abdominal incision is a rare variant in which the deep inferior epigastric vessels are ligated. This is clinically important and has significant implications for preoperative planning of reconstructive surgery based on these vessels. Four candidates for deep inferior epigastric perforator (DIEP) flap breast reconstruction were identified with a suspected Maylard incision prior to surgery. Preoperative imaging with Duplex ultrasound was important in select cases for identification of vessel patency and direction of flow. Identification of 'high-risk patients allows for appropriate patient counselling and surgical planning.