title: Case report. The use of both antegrade and retrograde internal mammary vessels in a folded, stacked deep inferior epigastric artery perforator flap.
abstract: OBJECTIVE
  Deep inferior epigastric artery perforator (DIEP) flap is an excellent option for breast reconstruction in young and active patients who have a history of chest wall radiation. One drawback, however, is that the entire capacity of abdominal pannus cannot be reliably transferred on a single pedicle. The purpose of this case report is to demonstrate a method of maximizing the volume of reconstruction with a dual-pedicled DIEP flap.
  
  
  METHODS
  A case is reported in which both antegrade and retrograde internal mammary vessels were used as recipient sites for a dual-pedicled, folded, stacked DIEP flap.
  
  
  RESULTS
  Good flows were observed in both sets of recipient vessels intraoperatively. Postoperative imaging revealed patent vascular anastomoses of both pedicles. At 1-year follow-up, there was no evidence of fat necrosis and a satisfactory aesthetic outcome was achieved.
  
  
  CONCLUSIONS
  To maximize the volume of the reconstructed breast, the entire abdominal pannus can be utilized. The retrograde limb of internal mammary vessels can act as the recipient site for the second pedicle, minimizing donor site morbidity.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02445, USA.
authors.forename: Rodney K
authors.initials: RK
authors.lastname: Chan
authors.forename: Wojitec
authors.initials: W
authors.lastname: Przylecki
authors.forename: Lifei
authors.initials: L
authors.lastname: Guo
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Caterson
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