Conjoined Deep Inferior Epigastric Artery Perforator and Superficial Inferior Epigastric Artery Free Flap...

Phyllodes tumors are rare fibroepithelial breast neoplasms that occasionally present as giant masses, requiring radical excision and complex reconstruction. We report the case of a 21-year-old woman who presented with a progressively enlarging right breast mass for more than 18 months, which had recently ulcerated and become symptomatic. Imaging showed a heterogeneous mass occupying the entire breast, with no distant metastases but axillary nodal enlargement. She underwent a radical mastectomy and sentinel lymph node biopsy. The specimen measured 22 × 17.5 × 14.5 cm and weighed 2440.5 g. Immediate reconstruction was performed using a conjoined abdominal free flap: a deep inferior epigastric artery perforator flap based on the left deep inferior epigastric vessels and a superficial inferior epigastric artery flap based on the right superficial system. Microvascular anastomoses were performed to the internal mammary and lateral thoracic branch pedicles. The final histology report confirmed a borderline phyllodes tumor with negative margins and no nodal involvement. Postoperative recovery was uneventful, and the patient was discharged on day 5. During follow-up, there was no evidence of recurrence, and the breast mound showed reasonable shape and projection. This case highlighted the value of conjoined abdominal free flaps as a reliable single-stage solution for immediate reconstruction following resection of giant phyllodes tumors, offering adequate soft tissue coverage and volume with low donor-site morbidity.