Thoracodorsal Composite Vascular Interposition Graft for Contralateral Stacked Lumbar Artery Perforator Flap Breast...

Alternative breast reconstruction techniques are needed when abdominally based breast reconstruction is unavailable or has insufficient volume. Secondary donor sites, such as the lumbar artery perforator flap, have gained popularity in this select patient population. Traditionally, this technique requires vascular interposition grafting to the internal mammary vessels due to the difficult dissection near the transverse processes, with an increased complication profile leading to a short pedicle length. The deep inferior epigastric vessels are most commonly used as an interposition graft in these cases; however, this graft may be unavailable and requires an additional donor site, resulting in an additional scar with increased donor site morbidity. Here, we present a successful case and indications for using the thoracodorsal composite vascular interposition graft for contralateral stacked lumbar artery perforator flap breast reconstruction.