# Salvage of a failed partial prosthetic breast reconstruction using a free deep inferior epigastric artery perforator (DIEP) flap

## TL;DR

A free deep inferior epigastric artery perforator flap successfully salvaged a failed partial prosthetic breast reconstruction, avoiding mastectomy.

## Contribution

This is the first reported use of a free flap to salvage a suboptimal partial prosthetic breast reconstruction.

## Key findings

- A free DIEP flap successfully salvaged a suboptimal TDAP flap with capsular contracture.
- Microvascular autologous conversion can address complex partial reconstructive issues.
- The approach avoided the need for completion mastectomy despite multiple complications.

## Abstract

Tertiary breast reconstruction with free tissue transfers is the gold standard in managing recalcitrant complications of implant-based whole breast reconstructions (WBRs). Whilst the salvage of implant-based WBR with free tissue transfers is well established, there have hitherto been no reports of free flap use for salvaging failed or suboptimal partial prosthetic breast reconstructions. We report a case of delayed partial breast reconstruction after lumpectomy and axillary clearance, where a deep inferior epigastric artery perforator flap successfully salvaged a suboptimal thoracodorsal artery perforator flap (TDAP) with underlying peri-implant capsular contracture, avoiding the need for completion mastectomy. The challenges encountered were complicated by severe capsular contracture, chronic pain, poor cosmesis, prior tissue rearrangement, radiotherapy changes, residual breast tissue, and scarring from a previous TDAP flap. Microvascular autologous conversion, a standard treatment of failed prosthetic WBRs, also has the versatility to salvage complex partial reconstructive dilemmas accentuated by prior radiotherapy and the presence of residual potentially compromised breast tissue.