Immediate DIEP Breast Reconstruction in a Trans Woman with Breast Cancer.

Breast cancer is a leading cause of cancer among cisgender women worldwide, with an incidence that continues to rise. Breast reconstruction is increasingly recognized as an integral part of breast cancer management. In tandem, the population of trans women is also increasing. However, few studies have focused on the management of breast cancer in this population, given that estrogen therapy has the potential to increase the risk of breast cancer. We present the case of a 51-year-old trans woman diagnosed with right breast cancer following a 32-year history of estrogen therapy. She presented to our clinic for consultation and immediate breast reconstruction. She opted for bilateral skin-sparing mastectomies, sentinel lymph node biopsies, and immediate breast reconstruction using deep inferior epigastric perforator free flaps. There were no postoperative flap complications. Final pathology revealed invasive mucinous carcinoma, devoid of lymph node involvement. The patient was satisfied with her reconstruction and is currently planning for nipple reconstruction. To the authors' knowledge, this is the first reported case in the literature of bilateral deep inferior epigastric perforator free flap reconstruction in the trans female population after breast cancer diagnosis. This case underscores the need for a holistic treatment approach and heightened vigilance among trans women on estrogen therapy. It also highlights that breast reconstruction should be considered and offered to this patient population.