Breast reconstruction using a deep inferior epigastric perforator flap (DIEP flap) harvested from beyond the midline of the abdomen often causes postoperative partial congestion and fat induration in the flap. In such cases, we prophylactically preserve the superficial epigastric veins (SEVs) and perforator vein of the flap, and add a venous outflow system by anastomosis of a combination of candidate intra-flap veins and the inferior epigastric vein to reduce flap congestion when intraoperative findings suggest flap congestion. As a result, fat necrosis was avoided in all 12 cases in which flap congestion was prevented. When intra-flap vein anastomosis is added, appropriate selection of a target vein is required depending on the anatomical position of the blood vessel in each case. The above measures do not require a new arterial anastomosis and may be able to prevent postoperative flap congestion with a relatively simple procedure.
