Robot-assisted Deep Inferior Epigastric Perforator Flap Breast Reconstruction: First Reported Case in the Middle East Gulf Region

Summary: Despite encouraging early outcomes, robot-assisted deep inferior epigastric perforator (DIEP) reconstruction has yet to be widely adopted because of its technical complexity, cost considerations, and limited institutional experience. We report the first robot-assisted DIEP flap breast reconstruction performed in the Middle East Gulf region. A 53-year-old woman with a history of breast cancer, prior irradiation, implant-based reconstruction, and severe capsular contracture underwent robot-assisted DIEP flap reconstruction using a transabdominal preperitoneal approach. Preoperative computed tomography angiography demonstrated a short intramuscular perforator course and nontortuous pedicle anatomy. Robotic pedicle harvest was completed through a 2-cm fascial incision and three 8-mm robotic ports, with a console time of 77 minutes. The flap was successfully transferred without intraoperative complications. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 3. At 5-month follow-up, there was no evidence of flap compromise, abdominal bulge, or hernia. This case demonstrates the technical feasibility of robot-assisted DIEP flap reconstruction in a carefully selected patient and highlights the successful implementation of robotic microsurgical breast reconstruction within a developing regional program. As the first reported robot-assisted DIEP flap reconstruction in the Middle East Gulf region, this report contributes to the growing but still limited global experience with robotic autologous breast reconstruction.