Alternative venous options when the internal mammary vein is unavailable in delayed breast reconstruction using a deep inferior epigastric artery perforator free flap: a case report

The internal mammary vessels are the preferred recipient vessels for free-flap breast reconstruction, particularly in delayed reconstruction, in which the thoracodorsal system may be compromised. However, anatomic variation, prior surgical disruption, and radiation-induced fibrosis can render the internal mammary vein unsuitable for venous outflow. We report the successful use of cephalic vein transposition as an alternative recipient vein during delayed breast reconstruction with a deep inferior epigastric artery perforator free flap. This case underscores the importance of preoperative planning for alternative venous options when unexpected intraoperative venous insufficiency is encountered.