Successful DIEP flap breast reconstruction in a patient with previous urostomy, abdominal liposuction, and caesarean section: a case report overcoming a relative contraindication

The deep inferior epigastric perforator (DIEP) flap is the most popular option in autologous breast reconstruction post-mastectomy. However, extensive prior surgical history, especially abdominal, urological and/or pelvic surgery are generally considered as relative contraindications to DIEP reconstruction. We report a case of a 63-year-old who successfully underwent breast reconstruction using a DIEP flap despite previous urological surgery and indwelling suprapubic catheter with significant adjacent scarring in addition to prior abdominal liposuction and caesarean section. The reconstruction was carried out with several intraoperative precautions, including flap harvest incorporating three perforators to optimise perfusion and reduce the risk of flap necrosis. Additionally, the contralateral abdominal hemi-flap was left attached until successful microvascular anastomoses were confirmed. The urostomy with its indwelling suprapubic catheter was isolated during surgery with a transparent waterproof dressing to reduce contamination of the operative field. To our knowledge, this is the first reported case of successful DIEP flap breast reconstruction in a patient with a pre-existing urostomy. This case further supports the notion that a complex abdominal surgical history should not be viewed as an absolute contraindication to DIEP flap reconstruction.