Medial Arm Flap: An Unexplored Option for Autologous Breast Reconstruction in the Setting of Morbid Obesity.

Currently, deep inferior epigastric perforator flap is undoubtedly the first choice for autologous breast reconstruction for most surgeons; however, there are instances where lower abdominal tissue is unavailable for microvascular transfer. In these cases, most surgeons choose gluteal or lower-extremity territories as donor sites.In the setting of morbid obesity, there is an increased risk of flap and donor site complications, as well as increased blood loss, surgical time, and risk of deep venous thrombosis, not to mention a more challenging surgical technique. Added to these problems, Tamoxifen intake and delayed or limited ambulation due to pain or surgical wounds increases deep venous thrombosis risk even further.The use of the upper arm as donor site for microvascular transfer avoids most of these problems and allows for immediate, comfortable ambulation. On the other hand, upper arm flaps have smaller caliber vessels for microanastomosis, shorter pedicles, and a limited amount of skin which makes them a viable option for only a select group of patients with redundant upper arm skin. We provide a previously undocumented proof-of-concept case report of a delayed breast reconstruction using the medial arm free flap that resulted in an uneventful postoperatory follow-up with a naturally textured and shaped reconstructed breast.