Endoscope-Assisted Deep Inferior Epigastric Perforator Flap for Breast Reconstruction: The First Reported Case in Japan

We report the first case of endoscope-assisted deep inferior epigastric perforator (E-DIEP) flap breast reconstruction in Japan. A 46-year-old woman underwent skin-sparing mastectomy with immediate reconstruction using a DIEP flap. Intramuscular perforator dissection was performed using an open approach, followed by pedicle harvesting using an endoscopic totally extraperitoneal technique. Consequently, a 14-cm pedicle was successfully obtained through a 3.5-cm fascial incision. Microsurgical anastomosis was performed via a mastectomy incision. Recovery was uneventful and the patient was discharged on postoperative day six without complications. This hybrid approach combines the advantages of minimal donor site morbidity and a long pedicle length, enabling tension-free anastomosis and safety. E-DIEP flap harvesting may serve as a practical and less-invasive alternative to robot-assisted techniques, particularly, in facilities where robotic systems are unavailable. This case demonstrated the feasibility and potential benefits of E-DIEP flap for clinical breast reconstruction.