Breast Reconstruction With Bipedicled DIEP Flap From an Irradiated and Scarred Abdomen

Autologous reconstruction using a deep inferior epigastric perforator (DIEP) flap is the gold standard due to its reliability and versatility. However, abdominal scarring and radiotherapy significantly impact vascularity, posing challenges to flap viability and donor site healing. We present a 48-year-old patient with Baker grade IV capsular contracture and significant abdominal scarring from multiple surgical procedures and radiotherapy. A delayed unilateral breast reconstruction was performed using a bipedicled DIEP flap. Preoperative planning included a computed tomography angiogram to identify perforators. Intraoperatively, a bipedicled design was used to optimize perfusion, incorporating perforators from both hemiabdomens. Standard abdominal closure and negative pressure wound therapy were used to minimize complications. The reconstruction was successful, with no postoperative complications. At 6 months, the patient reported satisfaction with her outcome, as reflected in her BREAST-Q scores. Donor site morbidity was minimized, and vascular safety was prioritized throughout the procedure. This case demonstrates the feasibility of bipedicled DIEP flap reconstruction in patients with significant abdominal scarring and radiotherapy. Careful preoperative planning, innovative surgical techniques, and prioritization of vascular safety are critical for achieving successful outcomes in complex reconstructive cases.