ePlasty: Vol. 19
Fat Grafting With Harvesting From Zone IV in the DIEP Flap
Yoshihiro Sowa, MD, PhD,Takuya Kodama, MD,Daiki Morita, MD,and Toshiaki Numajiri, MD, PhD

Departments of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan

Keywords: deep inferior epigastric artery perforator, fat grafting, breast reconstruction, breast augmentation, breast cancer


The patient was a 43-year-old woman with invasive ductal carcinoma in the left breast who was treated with skin-sparing mastectomy. She then underwent total breast reconstruction using a deep inferior epigastric artery perforator (DIEP) flap simultaneously with fat grafting with harvesting from zone IV in the DIEP flap. In the procedure, fat tissue was harvested from zone IV in the DIEP flap using the wet technique with a 3-mm cannula and a 20-mL Luer-Lok syringe under manually generated negative pressure (Fig 1). Fat was centrifuged at 2000 rpm for 2 minutes and then injected with a blunt Coleman cannula and 5-mL syringes. Fat injections were performed along the muscular fascicle of the pectoralis major in the subcutaneous tissue, if possible into the subcutaneous layer (Fig 2). The volume of the fat graft depends on the size of the harvested DIEP flap, but 20 to 30 mL of fat tissue can usually be injected. In this case, there was no local recurrence or systemic metastasis during a 2-year follow-up period, and no cysts were detected by .......