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

Phyllodes tumors are rare fibroepithelial breast neoplasms that occasionally present as giant masses, requiring radical excision and complex reconstruction. We report the case of a 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 2440.5 g. 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.