Suspected Brachial Plexus Neuropathy After Breast Reconstruction With Bilateral Deep Inferior Epigastric Perforator Flaps

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Summary: Perioperative brachial plexus injury has become relatively rare, as preventive positioning strategies are now widely implemented. We report the case of a female patient who underwent bilateral breast reconstruction with bilateral deep inferior epigastric perforator flaps for bilateral breast cancer and developed left upper limb neuropathy, despite careful intraoperative positioning measures. General anesthesia was induced, and the operative time was 10 hours and 36 minutes. The patient was positioned supine, with both upper limbs abducted to approximately 90 degrees and secured to arm boards with the forearms extended. The head was stabilized on the operating table using adhesive tape and a pillow. The patient was temporarily placed in a sitting position for approximately 4 minutes to assess the breast shape. Immediately after emergence from anesthesia, the patient reported weakness in left elbow flexion and a sensory disturbance extending from the radial side of the upper arm to the forearm. Physical examination suggested an upper trunk (C5–C6) brachial plexus lesion. Cervical magnetic resonance imaging revealed no obvious brachial plexus abnormality; however, mild C5–C6 cervical disc herniation was noted. At discharge, only mild forearm numbness persisted, and the symptoms had nearly resolved by 6 months. Although double crush syndrome was considered as a possible patient-related contributing factor, careful positioning may have helped prevent progression to a more severe neurological deficit. This case underscores the importance of comprehensive preoperative risk assessment and meticulous intraoperative positioning through collaboration among surgeons, anesthesiologists, and operating room staff.

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