Background and objective.

The current standard regarding delayed breast reconstruction is with autologous tissue using free perforator flaps, of these, the most widely used is the deep inferior epigastric artery perforator flap (DIEP).

The aim of this paper is to describe our experience in breast reconstruction techniques with microsurgical DIEP flaps describing the stages required for the optimization and remodeling of the flaps as an accessible option to achieve an aesthetically correct breast, with a natural contour and similar to the contralateral breast.

Methods.

We describe 3 representative clinical cases which exemplify modification technique in delayed breast reconstruction using a DIEP flap from the Reconstructive Surgery Department at San Juan de Dios Hospital which is part of the Costa Rican Social Security Health Fund (CCSS), in San José, Costa Rica between March 2015 and November 2019. The technique described establish 3 stages following standard procedures in each one of them in order to obtain better results. The first stage is the evaluation process and obtaining the flap; the second stage is remodeling of the flap and the contralateral breast; and the third stage is the reconstruction of the nipple-areola complex and the use of fat grafts.

Results.

Three post-mastectomy patients who underwent breast reconstruction through microsurgery with the DIEP flap technique are described. This process was carried out in a period of 8 to 23 months beginning with the first stage with the making of the flap; the second stage in a period of 6 months; and finally the third stage in a period of 2 to 17 months. The average age of the patients was 50.3 years and all had a previous diagnosis of infiltra- ting ductal carcinoma of the right breast. Two patients had a surgical procedure prior to the DIEP. In all cases the breast reconstruction was delayed: 2 of them secondary and 1 primary, with an average of 16.3 months to complete the 3 stages described here.

Conclusions.

In our experience, the technique modification performed in delayed breast reconstruction with DIEP flap using 3 stages has proven to be an effective and aesthetically viable alternative in low- and middle-income countries, such as ours.

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