Utilization of Superficial Circumflex Iliac Artery Perforators for Hemiabdominal Free Flap Breast Reconstruction

Deep inferior epigastric perforator flap reconstruction is the gold standard for autologous breast reconstruction. However, a patent deep inferior epigastric artery can sometimes be absent in patients who have undergone previous abdominal or gynecologic surgery, which poses a challenge for surgeons aiming for autologous reconstruction using lower abdominal tissue. Here, we present a case report of a 50-year-old woman with a history of low-transverse cesarean section and oophorectomy who underwent prophylactic bilateral skin-sparing mastectomy and immediate autologous breast reconstruction. A standard-of-care preoperative computed tomography angiogram revealed nonopacification of the deep inferior epigastric artery, prompting consideration of alternative vascular supplies. Intraoperatively, bilateral hemiabdominal flaps were successfully transferred using the superficial circumflex iliac artery perforasome. This case highlighted the importance of preoperative vascular imaging and intraoperative evaluation of alternative and viable vasculature. Moreover, this study emphasized the feasibility of freestyle hemiabdominal flaps in patients with abdominal tissue well vascularized by the superficial circumflex iliac artery.