Immediate Breast Reconstruction with Deep Inferior Epigastric Perforator Flap in a Patient with Previous Surgical Correction of Pectus Excavatum.

Pectus excavatum is a deformity of the chest wall characterized by a sternal depression and possibly cardiac and pulmonary compression. Procedures performed during infancy for its correction may disrupt local anatomy and pose challenges to breast and reconstructive surgeons during mastectomy and reconstruction. We present a case report of a 45-year-old woman who had a Ravitch procedure for pectus excavatum correction in infancy who was diagnosed with right breast cancer undergoing bilateral nipple-sparing mastectomy with immediate deep inferior epigastric perforator flap reconstruction. A computed tomography angiography was used to study chest and abdominal anatomy before surgery. Patient safely underwent immediate breast reconstruction with deep inferior epigastric perforator flaps using the internal mammary vessels as recipient vessels. This case highlights the importance of preoperative vascular imaging and proper communication between the breast and plastic surgery teams during reconstructive surgery. It also displays the safety of performing immediate breast reconstruction using free tissue transfer and the internal mammary vessels as recipients for microvascular anastomosis.