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Updated: May 26, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Secondary breast reconstruction using a cross-chest profunda artery perforator flap in a vessel-depleted chest: A
Thierry Schweizer1,2, Dariush Nikkhah1, Shadi Ghali1
1Department of Plastic Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London, United Kingdom.
Background:
Secondary autologous breast reconstruction is technically demanding, particularly in patients with depleted or compromised recipient vessels following prior surgery and radiotherapy.
Case:
We report a case of delayed unilateral breast reconstruction using a profunda artery perforator (PAP) flap anastomosed to contralateral internal mammary vessels after failure of primary DIEP flap reconstruction and radiation-induced ipsilateral vessel occlusion.
Results:
A double-perforator PAP flap with a 12-cm pedicle enabled tension-free presternal tunneling and successful microsurgical anastomosis. Indocyanine green angiography confirmed adequate perfusion. Postoperative recovery was uneventful, and follow-up demonstrated a stable reconstruction with a satisfactory aesthetic outcome.
Conclusion:
Cross-chest PAP flap reconstruction is a feasible and effective strategy in vessel-depleted chests and should be considered when conventional reconstructive options are exhausted.