Imaging donor site complications after autologous breast reconstruction flaps: a pictorial review

Autologous breast reconstruction using donor-site flaps such as the deep inferior epigastric perforator (DIEP) flap, transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, profunda artery perforator (PAP) flap, and autologous fat grafting is a cornerstone of post-mastectomy reconstruction, offering durable results and significant psychosocial benefits. Despite these advantages, donor site complications are common and can pose diagnostic challenges for radiologists. This pictorial review illustrates the spectrum of these complications, including seroma, hematoma, infection, fat necrosis, abdominal wall bulges and hernias, wound dehiscence focusing on their characteristic appearances across variety of modalities, primarily focused on computed tomography (CT), though also including radiography, ultrasound, and magnetic resonance imaging (MRI). By integrating surgical context with multimodality imaging features, this review provides practical guidance to distinguish expected postoperative changes from clinically significant complications, thereby improving diagnosis and facilitating early intervention for patients undergoing autologous breast reconstruction.