Staged Delay Procedure in DIEP Flap Breast Reconstruction in Patients with a History of Liposuction

Although deep inferior epigastric artery perforator (DIEP) flaps are a common option for breast reconstruction, there are limited data on outcomes in patients with a history of abdominal liposuction. Liposuction is one of the most popular aesthetic procedures performed around the world, with over 347,000 procedures performed in the United States in 2023. As the prevalence of both breast cancer and liposuction rises, plastic surgeons increasingly encounter patients interested in autologous breast reconstruction with prior liposuction history. However, the viability of the donor DIEP flap site is potentially compromised by scarring. Prior perforator injury, vessel patency issues, and the extent of prior abdominal procedures places patients who have undergone abdominal liposuction at an increased risk of complications. A staged delay procedure for DIEP flaps, performed before the DIEP flap procedure, may enhance blood flow and vessel caliber through augmentation of choke vessels, offering a potential solution for patients with previous liposuction. In this case series, we present 4 patients previously deemed unsuitable from outside hospitals for DIEP flap reconstruction because of a history of liposuction, with the majority successfully undergoing autologous breast reconstruction using a staged delay procedure and DIEP flaps. Preoperative imaging with computed tomographic angiography and intraoperative imaging with indocyanine green fluorescence angiography were used. This case series illustrates that staging a delay procedure before free flap breast reconstruction can be safely and effectively performed in this patient group, expanding reconstructive possibilities for this growing patient population.