Breast reconstruction with autologous abdomen-based free flap with prior abdominal liposuction - a case-based review

Over recent years, liposuction has become the most commonly used surgical procedure used to refine male and female body contours. In the last four decades, the incidence of breast cancer has increased. Of these patients, there are more women requiring breast reconstruction who have undergone liposuction in the past. There is little in the literature that discusses harvesting perforator flaps from previously liposuctioned donor sites. The authors report on their experience and review the current literature on the autologous abdominal-based free flap for breast reconstruction after previous liposuction of the abdominal wall.

Five electronic databases were searched (Medline (PubMed), Scopus, Web of Science, Cochrane) from inception to March 2021. Also, we searched our patients records and included our experience.

We included three cases who had previous liposuction prior to their breast reconstruction procedure. We report no flap loss in our cases. Moreover, the database search showed 30 patients (83.33%) underwent deep inferior epigastric perforator (DIEP) reconstruction. The age ranged from 32 to 73 years (mean of 51.7 years). The mean length of reconstruction after liposuction is 8.9 years, ranging from 1.5 years to 23 years reported in 23 patients. Seven patients (19.4%) had partial loss of the flap. Twenty patients (55.55%) had CT angiography pre-operatively for the assessment of the perforators.

A careful combination of preoperative scanning, handheld Doppler and clinical examination reduce the chance of an unsuccessful outcome.