Secondary Breast Reconstruction Using a Cross-Chest Profunda Artery Perforator Flap in a Vessel-Depleted Chest: A Case Report

Background:Secondary autologous breast reconstruction is technically demanding, particularly in patients with depleted or compromised recipient vessels following prior surgery and radiotherapy. Case:We report a case of delayed unilateral breast reconstruction using a profunda artery perforator (PAP) flap anastomosed to contralateral internal mammary vessels after failure of primary DIEP flap reconstruction and radiation-induced ipsilateral vessel occlusion. Results:A double-perforator PAP flap with a 12-cm pedicle enabled tension-free presternal tunnelling and successful microsurgical anastomosis.Indocyanine green angiography confirmed adequate perfusion.Postoperative recovery was uneventful, and follow-up demonstrated a stable reconstruction with a satisfactory aesthetic outcome. Conclusion:Cross-chest PAP flap reconstruction is a feasible and effective strategy in vessel-depleted chests and should be considered when conventional reconstructive options are exhausted.