Abstract
Breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap is now widely used. However, when the DIEP flap is not available, an alternative for patients who desire autologous breast reconstruction should be provided. This study aimed to introduce breast reconstruction with a lumbar artery perforator (LAP) flap for metachronous breast cancer that developed after contralateral breast reconstruction with a DIEP flap. A 45-year-old patient who developed metachronous breast cancer after contralateral breast reconstruction with a DIEP flap insisted on autologous breast reconstruction after metachronous breast cancer ablation. We chose the lumbar artery perforator (LAP) flap to ensure sufficient tissue volume and achieve a natural and symmetrical breast shape. Preoperative contrast-enhanced computed tomography indicated the presence of a large right fourth lumbar artery perforator. The LAP flap was harvested with a skin island size of 14×6 cm, including two perforators. The flap weight was 516 g, and the pedicle length was 2.5 cm. In addition, we used the left deep inferior epigastric artery, vein, and left superficial circumflex iliac vein (SCIV) for 6.0 cm as an interposition graft. The final length of the pedicle after DIEA and DIEV grafting was 8.5 cm. There were no postoperative complications. Six months postoperatively, the patient was satisfied with the shape and volume of the reconstructed breast and the donor site wound. A LAP flap may be an alternative option for patients who develop metachronous breast cancer after contralateral breast reconstruction with a DIEP flap.
