Secondary breast reconstruction using a cross-chest profunda artery perforator flap in a vessel-depleted chest: A case report.

BACKGROUND

Secondary autologous breast reconstruction is technically demanding, particularly in patients with depleted or compromised recipient vessels following prior surgery and radiotherapy.

CASE: We report a case of delayed unilateral breast reconstruction using a profunda artery perforator (PAP) flap anastomosed to contralateral internal mammary vessels after failure of primary DIEP flap reconstruction and radiation-induced ipsilateral vessel occlusion.

RESULTS

A double-perforator PAP flap with a 12-cm pedicle enabled tension-free presternal tunneling and successful microsurgical anastomosis. Indocyanine green angiography confirmed adequate perfusion. Postoperative recovery was uneventful, and follow-up demonstrated a stable reconstruction with a satisfactory aesthetic outcome.

CONCLUSION

Cross-chest PAP flap reconstruction is a feasible and effective strategy in vessel-depleted chests and should be considered when conventional reconstructive options are exhausted.