Double Medial Circumflex Femoral Artery Perforator Flaps for Unilateral Breast Reconstruction-A Case Report

Thigh-based free flaps are a common second-line options in autologous breast reconstruction when the abdominal donor site is unavailable. While the profunda artery perforator (PAP) flap and gracilis-based flaps are most commonly utilized in this scenario, certain anatomic variations may favor alternative flap selection. One such option is the medial circumflex femoral artery perforator flap (MCFLAP). This report describes a case of a 60-year-old patient with a history of abdominoplasty and left breast cancer who underwent skin sparing mastectomy, adjuvant radiation, and ultimately, unilateral autologous breast reconstruction using stacked MCFLAPs. While PAP flaps were initially considered, preoperative CT imaging revealed large septocutaneous perforators originating from the MCFA system, bilaterally. The flaps were designed and harvested on these perforators and weighed 335 g on the right and 355 g on the left. The internal mammary system was accessed at the level of the third rib, and the anterograde and retrograde artery and vein were used as recipient vessels. The patient did not experience any complications postoperatively. A revisionary and symmetrizing procedure was performed several months later, and at 18 months, the patient had completely healed and reported satisfaction with the reconstruction. In addition to a detailed case description, the purpose of this report is to provide a review of the available literature on the MCFLAP including the anatomy, indications, and potential benefits and downfalls of this rare perforator flap. While the PAP flap is our preferred second-line option for autologous breast reconstruction, it is important to be aware that in some instances the more suitable perforators may be arising from the MCFA system. In such cases, the MCFLAP should be considered.