Abdominal flaps are often used in breast reconstruction. We report a case of muscle-sparing ( MS-2 ) free transverse rectus abdominis musculocutaneous ( TRAM ) flap breast reconstruction after abdominal liposuction. A 65-year-old woman had right invasive ductal carcinoma. Unaware that she had a history of abdominal liposuction, we raised a free TRAM flap with the deep inferior epigastric artery and concomitant vein. During the operation, scarring was observed on the rectus abdominis fascia. Initially, we performed anastomosis between the right internal thoracic vein and deep inferior epigastric vein. Due to flap congestion, we attempted salvage with additional anastomosis using the superficial inferior epigastric vein ( SIEV ), but flap congestion did not improve. Finally, the right internal thoracic vein and left SIEV were anastomosed with a vein graft. It was then possible to alleviate flap congestion by anastomosing the SIEV to the left internal thoracic vein. When a patient has a history of abdominal liposuction, selection and adaptation of the flap for harvest should be carefully determined considering the possibility of TRAM flap congestion while harvesting the flap.
