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Background: Salvage breast reconstruction is a procedure to recreate the breast mound after previous attempts at breast reconstruction. It can be achieved through the positioning of breast implants or the transfer of autologous tissue, whether pedicled or free. We present here a peculiar case of quaternary breast reconstruction in which the patient asked us not to use implants nor complex autologous free-flap transfer. The reconstruction was carried out using two perforator flaps which are common flaps for chest wall reconstruction. To our knowledge this is the first time these flaps have been applied for a case of complete breast reconstruction.

Case Description: We present here the case of a 52-year-old, healthy woman, who asked for a salvage breast reconstruction after three previous failed attempts, both with implants and autologous tissue transfer [latissimus dorsi (LD) flap]. Given the unwillingness of the patient to undergo further complex surgeries, we decided to avoid any microsurgical procedure, choosing to reconstruct the breast volume using two perforator flaps [internal mammary artery perforator (IMAP) flap and superior epigastric artery perforator (SEAP) flap] instead. The patient experienced no complications and after 2 months she was readmitted to our department for the first touch-up surgery, consisting in autologous fat grafting and reshaping of the flaps. Three months post-operative the patient is aware that other touch-up surgeries are scheduled and she is satisfied with the results achieved so far.

Conclusions: Autologous breast reconstruction allows the surgeon to transfer autologous tissue to redefine the volume and contour of the …