First reported case of bilateral DIEP flap reconstruction following BIA-ALCL in a transgender female patient

The prevalence of individuals with gender dysphoria is increasing. With recent advances in health care and societal support, appropriate treatment has become more accessible, leading to an increased demand for gender-affirming care. Chest feminization surgery is a critical component of management, with breast enhancement using implants being one of the most sought-after physical modifications in this population. However, as the demand for implants rises, so does the awareness of a rare condition: breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL), an uncommon type of peripheral T-cell lymphoma. Transgender women are often excluded from routine breast screening and follow-up programs, which can result in delayed recognition and diagnosis of this condition. Nevertheless, BIA-ALCL generally presents as a localized disease with an excellent prognosis when treated with en bloc total capsulectomy. After surgery, the issue arises of how to proceed with the reconstructive process. We report the first case of breast reconstruction in a transgender woman with bilateral DIEP flaps after successful treatment of BIA-ALCL. In this context, autologous breast reconstruction strikes as a safe and feasible surgical technique that, when performed by skilled surgeons, achieves not only good aesthetic results but also safety goals.