PMC6916620_01
Preoperative photograph. Bilateral tissue expander reconstruction 9 months after completion of right breast radiation therapy.
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F1
A 40-year-old woman with stage IIb right invasive ductal carcinoma underwent bilateral skin-sparing mastectomy and immediate subpectoral tissue expander breast reconstruction in anticipation of right breast adjuvant radiation (Fig 1). Her final result can be seen in Figure 5 over 1 year later.
Postoperative day 4 acute venous congestion of the right deep inferior epigastric perforator flap.
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F2
Upon ambulation postoperative day 4, she had recurrent venous congestion and loss of venous signal and was urgently taken to the operating room for exploration (Fig 2).
Intraoperative photograph of the right radiated mastectomy skin flap released from the deep inferior epigastric perforator flap skin paddle and resolution of venous congestion. Bilaminar wound matrix interposed between the flap and mastectomy skin. (Blue circle marks approximate the perforator location.)
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F3
The flap inset was therefore left open, and the cause of congestion was determined to be compression (Fig 3).
Recurrent venous congestion of the right deep inferior epigastric perforator flap noted 5 weeks postoperatively.
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F4
The flap completely recovered and had a normal examination until 5 weeks postoperatively when the patient presented again with acute venous congestion (Fig 4).
Final result over 1 year later.
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F5
Her final result can be seen in Figure 5 over 1 year later.