Autologous augmentation of contralateral native breast in conjunction with unilateral abdominal-based free flap breast reconstruction: case series and literature review

In autologous breast reconstruction, the deep inferior epigastric perforator (DIEP) flap is the most commonly used. For patients undergoing unilateral breast reconstruction who desire augmentation of the contralateral breast but wish to avoid using implants, augmentation of the contralateral breast using DIEP flaps is a reliable option. Preoperative evaluation requires assessing the patient's desired outcome and the amount of abdominal tissue available. CT angiography (CTA) helps facilitate the evaluation of abdominal perforator anatomy and the estimation of flap volumes for simultaneous reconstruction and contralateral augmentation. Flap design takes into consideration the perforators needed for a large flap for the primary reconstruction and the length of the pedicle needed to access contralateral recipient vessels for a smaller flap for augmentation. One set of recipient vessels [internal mammary artery (IMA)/internal mammary vein (IMV)] are used with antegrade anastomoses performed for primary reconstruction flaps and retrograde anastomoses for flaps used in augmentation. Augmentation flaps can be completely buried or include a skin paddle for monitoring. Subsequent secondary procedures are often needed to achieve the desired final breast shape and symmetry. Overall, patients who have undergone unilateral autologous breast reconstruction with simultaneous contralateral autologous augmentation report high levels of satisfaction postoperatively.