A Rare Complication of Lichen Simplex Chronicus Following Deep Inferior Epigastric Perforator Flap Reconstruction

Autologous breast reconstruction using deep inferior epigastric perforator (DIEP) flaps is widely regarded as the gold standard technique, offering excellent aesthetic outcomes and reduced donor site morbidity. However, dermatological complications affecting either the reconstructed breast or donor site are infrequently reported and often under-recognized. This manuscript aims to raise awareness of a rare dermatological complication following DIEP flap reconstruction and to discuss its diagnostic and therapeutic considerations. We report a case of a 49-year-old woman who developed a persistent, pruritic rash of the neo breast and abdominal donor site following DIEP flap reconstruction. Surgery formed part of the treatment of a T1aN0M0 invasive ductal carcinoma of the right breast. The patient did not require post-surgical radiotherapy. A biopsy confirmed the diagnosis of lichen simplex chronicus (LSC), a chronic pruritic dermatosis characterized by thickened, scaly plaques resulting from repetitive scratching. To our knowledge, this is the first reported case of LSC occurring specifically within the skin of the transplanted DIEP flap and its donor site. We discuss diagnosis, potential contributing factors - including surgical trauma and possible allergic contact dermatitis - and outline the successful treatment approach using topical corticosteroids and emollients. This case highlights a rare dermatological complication following autologous breast reconstruction and the importance of considering LSC in the differential diagnosis of post-surgical rashes.