Conjoined Deep Inferior Epigastric Artery Perforator and Superficial Inferior Epigastric Artery Free Flap Reconstruction After Excision of a Giant Phyllodes Tumor

Sep 29, 2026

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Phyllodes tumors are rare fibroepithelial breast neoplasms that can present as giant masses, often requiring radical excision and complex reconstruction. The article reports a 21-year-old woman with a progressively enlarging right breast mass for over 18 months, eventually ulcerating and becoming symptomatic. After right mastectomy and sentinel node biopsy, immediate reconstruction used a conjoined abdominal free flap combining a DIEP and SIEA component with microvascular anastomoses to recipient vessels. Final pathology showed a borderline tumor with negative margins and no nodal involvement. Recovery was uneventful, with no recurrence on follow-up and acceptable breast contour.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Summary

Case report

Presentation and diagnostic workup

Surgical management and specimen findings

Immediate reconstruction with conjoined flaps

Pathology and postoperative course

Case RepoRt Breast Conjoined Deep Inferior Epigastric Artery Perforator and Superficial Inferior Epigastric Artery Free Flap Reconstruction After Excision of a Giant Phyllodes Tumor Bernardo R. Cavadas, MD* Luís M. Ribeiro, MD* LuísVieira, MD* Carolina Morgado, MD† Clara Sampaio, MD† Manuela Martins, MD‡ Carlos Vitorino, MD† Summary: Phyllodes tumors are rare fibroepithelial breast neoplasms that occasionally present as giant masses, requiring radical excision and complex reconstruction. We report the case ofa 21-year-old woman who presented with a progressively enlarging right breast mass for more than 18 months, which had recently ulcerated and become symptomatic. Imaging showed a heterogeneous mass occupying the entire breast, with no distant metastases but axillary nodal enlargement. She underwent a radical mastectomy and sentinel lymph node biopsy. The specimen measured 22 × 17.5 × 14.5 cm and weighed 2440.5g. Immediate reconstruction was performed using a conjoined abdominal free flap: a deep inferior epigastric artery perforator flap based on the left deep inferior epigastric vessels and a superficial inferior epigastric artery flap based on the right superficial system. Microvascular anastomoses were performed to the internal mammary and lateral thoracic branch pedicles. The final histology report confirmed a borderline phyllodes tumor with negative margins and no nodal involvement. Postoperative recovery was uneventful, and the patient was discharged on day 5. During follow-up, there was no evidence of recurrence, and the breast mound showed reasonable shape and projection. This case highlighted the value of conjoined abdominal free flaps as a reliable single-stage solution for immediate reconstruction following resection of giant phyllodes tumors, offering adequate soft tissue coverage and volume with low donor-site morbidity.(Plast Reconstr Surg Glob Open 2026;14:e7374; doi: 10.1097/GOX.0000000000007374; Published online 5 January 2026.) Phyllodes tumors are rare fibroepithelial neoplasms that account for approximately 0.3%–0.5% of all female breast tumors. Although they most commonly occur in women between the ages of 35 and 55 years, they can also present less frequently in adolescent patients or older patients.1,2 The average size of phyllodes tumors is approximately 4 cm. However, around 20% of cases exceed 10 cm, the threshold used to define giant tumors. In rare From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Unidade Local de Saúde de São José, Lisboa, Portugal;†Department of General Surgery (Breast Unit), Unidade Local de Saúde de São José, Lisboa, Portugal; and ‡Department of Anatomic Pathology, Unidade Local de Saúde de São José, Lisboa, Portugal. Received for publication June 23, 2025; accepted October 28, 2025. Copyright © 2026 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. DOI: 10. 1097/GOX.0000000000007374 cases, these lesions can grow up to 40 cm in diameter.1,3 Although breast-conserving surgery may be feasible for smaller tumors, larger lesions often require mastectomy to ensure complete excision and reduce the risk of local recurrence.4 Such extensive resections result in large defects that pose significant reconstructive challenges. We present a rare case in which a conjoined deep inferior epigastric artery perforator (DIEP) flap and superficial inferior epigastric artery (SIEA) flap were used to address the complex defect following the removal of a giant phyllodes tumor. CASE REPORT A 21-year-old female university student, previously healthy and with no regul

FAQs

What clinical problem does the case address?

A giant phyllodes tumor of the right breast requiring radical excision and immediate reconstruction of a large defect.

How was the immediate reconstruction performed?

Using a conjoined abdominal free flap that combined a deep inferior epigastric artery perforator (DIEP) flap and a superficial inferior epigastric artery (SIEA) flap with microvascular anastomoses.

What were the key pathology and follow-up outcomes?

Histology confirmed a borderline phyllodes tumor with negative margins and no nodal involvement; postoperative recovery was uneventful and follow-up showed no evidence of recurrence with reasonable breast projection.

Sep 29, 2026

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