title: DIEP breast reconstruction following multiple abdominal liposuction procedures.
abstract: OBJECTIVE
  Previous abdominal wall surgery is viewed as a contraindication to abdominal free tissue transfer. We present two patients who underwent multiple abdominal liposuction procedures, followed by successful free deep inferior epigastric artery perforator flap. We review the literature pertaining to reliability of abdominal free flaps in those with previous abdominal surgery.
  
  
  METHODS
  Review of case notes and radiological investigations of two patients, and a PubMed search using the terms "DIEP", "deep inferior epigastric", "TRAM", "transverse rectus abdominis", "perforator" and "laparotomy", "abdominal wall", "liposuction", "liposculpture", "fat graft", "pfannenstiel", with subsequent appraisal of relevant papers by the first and second authors.
  
  
  RESULTS
  Patient 1 had 3 episodes of liposuction from the abdomen for fat grafting to a reconstructed breast. Subsequent revision reconstruction of the same breast with DIEP flap was preceded by CT angiography, which demonstrated normal perforator anatomy. The reconstruction healed well with no ischaemic complications. Patient 2 had 5 liposuction procedures from the abdomen to graft fat to a wide local excision defect. Recurrence of cancer led to mastectomy and immediate reconstruction with free DIEP flap. Preoperative MR angiography demonstrated a large perforator right of the umbilicus, with which the intraoperative findings were consistent. The patient had an uneventful recovery and good healing with no fat necrosis or wound dehiscence.
  
  
  CONCLUSIONS
  We demonstrate that DIEP flaps can safely be raised without perfusion-related complications following multiple liposuction procedures to the abdomen. The safe interval between procedures is difficult to quantify, but we demonstrate successful free flap after 16 months.
authors: Department of Plastic Surgery, Hull and East Yorkshire NHS Trust, Hull, United Kingdom.
authors: Mohammed
authors: M
authors: Farid
authors: Department of Plastic Surgery, Hull and East Yorkshire NHS Trust, Hull, United Kingdom.
authors: Simon
authors: S
authors: Nicholson
authors: Department of Plastic Surgery, Hull and East Yorkshire NHS Trust, Hull, United Kingdom.
authors: Ashutosh
authors: A
authors: Kotwal
authors: Department of Plastic Surgery, Hull and East Yorkshire NHS Trust, Hull, United Kingdom.
authors: Augustine
authors: A
authors: Akali
keywords: DIEP; angiography; breast reconstruction; free flap; liposuction