What happened, in summary

A 59-year-old woman with hypertension, type 2 diabetes and other chronic conditions was diagnosed with a small right-breast ductal carcinoma. Pathology showed a small, node-negative, grade 2 ductal carcinoma with clear margins, consistent with Stage I disease.

She underwent a right subcutaneous mastectomy with sentinel lymph-node biopsy and immediate implant reconstruction. One month later, with a BMI of 50.8 kg/m², she developed skin necrosis over the reconstructed breast. The implant was removed, devitalized tissue was debrided and negative-pressure wound therapy was applied.

One week later, she chose autologous reconstruction rather than another implant. A right deep inferior epigastric perforator, or DIEP, flap was transferred from the abdomen to the chest. During the operation, 2 small abdominal hernias were found and repaired, and the umbilicus was repositioned about 2 cm higher.

After surgery, she developed an infection at the abdominal donor site and needed several additional wound debridements. The breast flap itself remained healthy. At 3 months, there was no fat or skin necrosis of the flap and the aesthetic result was satisfactory. She declined a later procedure to improve symmetry of the opposite breast.