片側内胸動静脈を用いて両側分割DIEP Flapにて両側乳房再建を行った1例

抄録

　Autologous breast reconstruction has an important role in improving post-mastectomy quality of life. With increasing attention to hereditary breast and ovarian cancer syndrome, the number of patients undergoing bilateral mastectomy and requesting bilateral reconstruction is expected to increase. A deep inferior epigastric artery perforator (DIEP) flap is widely used because it allows for sufficient volume reconstruction while preserving the abdominal muscles. Conventionally, bilateral breast reconstruction using DIEP flaps requires the bilateral internal mammary artery and vein (IMA and IMV, respectively) as recipient vessels. Here, we report a case of bilateral breast reconstruction using bilateral DIEP flaps anastomosed exclusively to a unilateral internal mammary vascular system. A 47-year-old woman with hereditary breast and ovarian cancer syndrome underwent bilateral mastectomy, followed by delayed bilateral breast reconstruction using bilateral DIEP flaps. The left IMA and IMV were preserved, and both flaps were anastomosed to the right IMA and IMV. One flap was transferred through a pre-sternal tunnel into the contralateral breast pocket. Both flaps survived without post-operative complications, and satisfactory aesthetic outcomes were maintained during a 2-year follow-up. This case suggests that bilateral DIEP flap breast reconstruction using a unilateral internal mammary vessel system is a feasible and safe option for some patients.