This series describes the double DIEP flap as a good option for unilateral breast reconstruction to overcome the problems of insufficient donor site tissue based on a single deep inferior epigastric vascular pedicle or for patients with an abdominal midline scar. Two DIEP free flaps are used to shape the new breast mound with vascular inflow supplied by the thoracodorsal vessels and the internal mammary vessels.

Seven women, aged 31 to 63 years, had double DIEP flaps performed between July 1999 and May 2003. Three patients had an infra-umbilical midline scar. Three desired sufficient breast size to match the contralateral breast and one had previous bilateral S-GAP flap breast reconstruction with one flap failure. Risk factors included: 2 patients with BMI>30, 2 smokers and 2 with previous radiotherapy. Six patients had a delayed procedure and one was immediate. Overall 14 free flaps were performed. 64%(n=9) were based on a single perforator, 29%(n=4) were based on two and 7%(n=1) was based on three. The thoracodorsal and internal mammary vessels were used as recipient vessels in 6 patients. In the patient who had a previous S-GAP flap failure, the thoracodorsal vessels and serratus branches were used. The mean operative duration was 8h.The mean hospital stay was 3.14 days and the mean postoperative follow-up period was 9 months. One patient presented with congestion of one flap that resolved progressively over 3 weeks. No other breast or donor site complications were encountered. All patients had a mean of 1.14 secondary procedures for breast mound shaping, scar revision and nipple reconstruction including 4 patients who also had mastopexy or reduction surgery on the contralateral breast for symetry.

Double DIEP flaps provide a unique resolution for unilateral breast reconstruction with sufficient tissue and blood flow while minimizing donor site morbidity.