First free microvascular deep inferior epigastric perforator (DIEP) flap for autologous breast reconstruction in Mali: a case report

Introduction: Access to comprehensive breast cancer care, including reconstructive surgery, remains limited in many low-resource settings, such as Mali. While autologous breast reconstruction using free flaps is well established in high-income countries, its implementation in resource-constrained environments is challenging due to infrastructural and workforce limitations. This case report describes the feasibility of microsurgical breast reconstruction within a collaborative international setting. Presentation of case: A 38-year-old woman with a history of left-sided radical mastectomy for triple-negative breast cancer successfully underwent autologous breast reconstruction using a free DIEP flap. The procedure was performed during a collaborative surgical mission involving Swiss and Malian plastic surgeons. Despite limited preoperative imaging and intraoperative resources, the flap demonstrated reliable perfusion. Postoperative follow-up was conducted locally by a Malian plastic surgeon. Discussion: This case highlights the challenges and suggests the feasibility of microsurgical breast reconstruction in selected patients in a low-resource setting. Key limiting factors include restricted access to oncologic therapies, absence of advanced imaging modalities, limited microsurgical infrastructure, and constrained postoperative monitoring. The collaborative approach, with active local surgical involvement, represents a step toward sustainable capacity building. Conclusion: Microsurgical breast reconstruction using a DIEP flap appears feasible in selected patients in a low-resource setting when embedded within a collaborative framework. Long-term sustainability depends on local training, infrastructure development, and integration into existing healthcare systems.