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CC BY 4.0 · Arch Plast Surg 2026; 53(01): 129-132
DOI: 10.1055/a-2710-4367
Communication

Personal Strategies for DIEP Flap Breast Reconstruction in Patients with Prior Abdominal Surgery and Hernia Repairs

Authors

  • Samarth Gupta 

    1   Department of Reconstructive and Microvascular Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

  • Rajan Arora 

    1   Department of Reconstructive and Microvascular Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

  • Kripa Mishra 

    1   Department of Reconstructive and Microvascular Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

  • Anchit Kumar 

    1   Department of Reconstructive and Microvascular Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

  • Nikhil Prasad 

    1   Department of Reconstructive and Microvascular Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

Funding Information None.
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Abstract

Delayed breast reconstruction using deep inferior epigastric perforator (DIEP) flaps in patients with a history of abdominal wall hernias and/or cesarean sections presents unique challenges. This study examines 10 such cases, emphasizing key technical considerations. Our findings highlight the importance of lateral row perforators, as medial paraumbilical perforators are often compromised in patients with prior umbilical hernia repairs. Additionally, deep inferior epigastric arteries (DIEAs) may be damaged in previous lower abdominal surgeries, necessitating intraoperative confirmation of vessel patency. While preoperative CT angiography aids in planning, it may misrepresent perforator size or location due to adherence to fascia. In our approach, a gastrointestinal surgeon performed concurrent hernia repair while the plastic surgery team secured the DIEP flap perforators and pedicle. Preservation of umbilical vascularity was ensured by avoiding complete skeletonization. In the case shown, only a single lateral row perforator was usable, despite preoperative imaging suggesting additional perforators. All patients had successful flap integration, with no cases of flap failure, necrosis, postoperative hernias, wound dehiscence, seroma, hematoma, or infection. A delayed flap inset was performed using the Rosebud technique, ensuring optimal aesthetic outcomes and high patient satisfaction. This study highlights the critical role of a multidisciplinary approach, precise perforator identification, and careful interpretation of preoperative imaging in achieving optimal outcomes in complex DIEP flap breast reconstruction.

Keywords

DIEP flaps in hernia - abdominal scars and DIEP - breast reconstruction

Contributors' Statement

S.G. conceptualized the study, performed the majority of surgical procedures, collected clinical data, prepared the figures, and drafted the manuscript.

R.A. contributed to data collection, case analysis, and assisted in manuscript preparation and revision.

K..M. assisted in literature review, data validation, and manuscript editing.

A.K. participated in patient management, intraoperative documentation, and postoperative follow-up assessment.

N.P. contributed to data interpretation, tabulation, and critical review of the manuscript for intellectual content.

All authors reviewed and approved the final version of the manuscript and agree to be accountable for all aspects of the work.


Ethical Approval

The study was conducted in compliance with IRB regulations and under appropriate approval.


Informed Consent

Informed consent was obtained from the patient for the use of their photograph and medical record for educational and publication purposes.




Publication History

Received: 02 April 2025

Accepted: 16 September 2025

Accepted Manuscript online:
26 September 2025

Article published online:
30 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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