Neurotized Dual-pedicle Deep Inferior Epigastric Perforator Flap With Vascularized Lymph Node Transfer for Unilateral Breast Reconstruction

Background: – We describe clinical outcomes of combining a dual-pedicle deep inferior epigastric perforator (DIEP) flap, direct neurotization, and vascularized lymph node transfer (VLNT) for unilateral reconstruction in patients with breast cancer–related lymphedema or high risk of lymphedema. Methods: – A retrospective review identified consecutive patients who underwent the composite procedure by a single surgeon from February 2018 to February 2020. Lymphedema status and breast sensation were evaluated clinically at routine follow-up (median, 11.5 mo [range, 9.9–24.5 mo]). Results: – Five women (mean age 49 y, mean body mass index 23 kg/m²) underwent neurotized dual-pedicle DIEP with VLNT, 1 immediate and 4 delayed reconstructions. Mean operative time was 488 minutes (median, 480 min [range, 390–555 min]). Length of stay averaged 3.5 days (range, 3–4 d). No total or partial flap loss, donor-site hernia, seroma, hematoma, wound dehiscence, or 30-day reoperations occurred. Four patients experienced complete clinical resolution of upper extremity lymphedema; the remaining patient improved from stage II to stage I disease and continues compression therapy. All patients reported protective sensation in the reconstructed breast by 6 months. Secondary symmetry refinements included fat grafting (4 patients; mean 66 mL) and 1 implant augmentation. No donor-site lower extremity lymphedema was observed. Conclusions: – Combining a dual-pedicle DIEP flap, flap neurotization, and VLNT is technically feasible and, in this pilot series, achieved reliable breast reconstruction while simultaneously addressing lymphedema and sensory restoration without added morbidity.