Implant-Free Breast Volume Restoration Using Abdominal Free Flaps in Non-Oncologic Patients: A Retrospective Cohort Study

Abstract Background Abdominal free flaps are established in oncologic breast reconstruction but are less frequently used for implant-free breast volume restoration in non-oncologic patients. Objectives To describe the indications, operative characteristics, complications, follow-up, and secondary procedures associated with abdominal free flap breast reconstruction or augmentation in a non-oncologic cohort. Methods We performed a retrospective single-center cohort study of consecutive patients who underwent deep inferior epigastric perforator (DIEP) or muscle-sparing transverse rectus abdominis myocutaneous (msTRAM) flap transfer for non-oncologic indications between 2004 and 2025. Patients undergoing reconstruction for oncologic breast disease were excluded. Clinical, operative, and outcome data were extracted from medical records. Surgical complications were categorized according to timing and requirement for reoperation. Elective secondary procedures were recorded separately. Results Fourteen patients underwent 22 abdominal free flap reconstructions, including 19 DIEP and 3 msTRAM flaps. Primary indications were congenital breast deformity in 8 patients, primary autologous augmentation in 3, revision after aesthetic augmentation in 2, and sequelae of breast abscess in 1. Implant-associated problems were present in 8 patients. Median follow-up was 35.6 months (range, 8.2–248.5 months). No total flap loss occurred. Unplanned reoperations were required in 4 of 22 reconstructions, including 1 during the index admission and 3 after discharge. Elective secondary procedures were performed in 4 of 14 patients. Conclusions In this small, heterogeneous retrospective cohort, abdominal free flaps restored breast volume without total flap loss. Unplanned reoperations and elective secondary procedures occurred during the observed follow-up period.