DIEP breast reconstruction in a patient with an unknown Raynaud's phenomenon: A reflection on microvascular disorders and free flaps.

Free flap reconstructions are the gold standard in autologous breast reconstruction. Although free flap reconstruction in a patient with Raynaud's phenomenon is not a contraindication, this phenomenon must be recognized by the surgeon and all the necessary measures taken. If the surgeon is aware of this particularity, he will be prepared to take the necessary measures in the immediate postoperative period. The presence of Raynaud's phenomenon can influence the immediate postoperative evolution of a free flap by making it difficult to monitor. We present a case of a 50-year-old woman with an unknown Raynaud's phenomenon who underwent breast reconstruction using a free DIEP flap. She was referred to our department where a one-stage reconstruction was performed using a free deep inferior epigastric artery perforator (DIEP) flap. The postoperative course of the flap progressed from pale to cyanotic to mottled, an evocative appearance for Raynaud's phenomenon. At the three-month follow-up evaluation, the aesthetic result was satisfactory, despite a worrying postoperative appearance. Good outcomes are possible by using appropriate methods in the postoperative period, even if the clinical evolution of the flap is atypical. By taking into account and specifically treating Raynaud's phenomenon, the flap was preserved with an usual result.