Hemiabdominal Deep Inferior Epigastric Perforator Flap Banking for Contralateral Occult Breast Cancer

The deep inferior epigastric perforator (DIEP) flap is the gold standard in autologous breast reconstruction. Because abdominal tissue is limited to a single use, metachronous contralateral breast cancer reconstruction frequently necessitates an alternative donor site, raising concerns about symmetry and additional scarring. We propose using a hemi-DIEP flap for the initial reconstruction while preserving the unused contralateral hemi-flap subcutaneously in the abdominal region for future use. The patient is a 69-year-old woman diagnosed with invasive ductal carcinoma of the right breast. The patient underwent a nipple-sparing mastectomy with sentinel lymph node biopsy, followed by immediate breast reconstruction using a hemi-DIEP flap. The unused hemi-DIEP flap was denuded and stored subcutaneously in the lower abdominal region. The abdominal donor site healed with only mild midline thickening, without bulging or cosmetic deformity, resulting in an appearance comparable to a standard DIEP flap harvest. For high-risk patients with contralateral breast cancer, this approach provides a promising autologous breast reconstruction alternative that reduces donor-site morbidity while ensuring optimal symmetry and tissue quality.