A curious instance of an immediate abandoned "delayed" immediate DIEP

The deep inferior epigastric artery (DIEP) flap is the gold standard for breast reconstruction. While vascular delay has been described in the literature as a means of salvaging DIEP flaps that show evidence of compromise on the abdomen, or to recruit additional abdominal tissue, this is not routine clinical practice. We describe a case where immediate bilateral breast reconstruction was abandoned following complete raise of both hemi-DIEP flaps to the level of the venous confluence, due to unforeseen circumstances. Flaps were re-raised and successfully transferred 10 weeks after the primary surgery. The authors report that scarring surrounding the vascular pedicle following such significant length of delay, together with seroma, can facilitate repeat dissection, however, greater care is required when insetting to avoid twisting or kinking of the more rigid pedicle.