Fat Grafting With Harvesting From Zone IV in the DIEP Flap

Yoshihiro Sowa, MD, PhD; Takuya Kodama, MD; Daiki Morita, MD; Toshiaki Numajiri, MD, PhD

Disclosures

ePlasty. 2019;19(ic14) 

In This Article

Case Description

The patient was a 43-year-old woman with invasive ductal carcinoma in the left breast who was treated with skin-sparing mastectomy. She then underwent total breast reconstruction using a deep inferior epigastric artery perforator (DIEP) flap simultaneously with fat grafting with harvesting from zone IV in the DIEP flap. In the procedure, fat tissue was harvested from zone IV in the DIEP flap using the wet technique with a 3-mm cannula and a 20-mL Luer-Lok syringe under manually generated negative pressure (Figure 1). Fat was centrifuged at 2000 rpm for 2 minutes and then injected with a blunt Coleman cannula and 5-mL syringes. Fat injections were performed along the muscular fascicle of the pectoralis major in the subcutaneous tissue, if possible into the subcutaneous layer (Figure 2). The volume of the fat graft depends on the size of the harvested DIEP flap, but 20 to 30 mL of fat tissue can usually be injected. In this case, there was no local recurrence or systemic metastasis during a 2-year follow-up period, and no cysts were detected by ultrasonography, indicating that no fat necrosis occurred. The patient was highly satisfied with the cosmetic results (Figure 3).

Figure 1.

Intraoperative image showing fat tissue suction from zone IV in the DIEP flap using the wet technique with a 3-mm cannula and a 20-mL Luer-Lok syringe. DIEP indicates deep inferior epigastric artery perforator.

Figure 2.

Intraoperative image showing additional fat grafting in the pectoralis major muscle.

Figure 3.

Postoperative image of the patient 1 year after left breast skin–sparing mastectomy and DIEP flap reconstruction combined with fat grafting with harvesting from zone IV in the DIEP flap. DIEP indicates deep inferior epigastric artery perforator.

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