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We describe a salvage procedure during bilateral free flap breast reconstruction due to insufficient venous drainage using a venous cross\u2010over bypass. A 54\u2010year\u2010old woman with a thrombosis of the left subclavian port\u2010system in the medical history was elected for simultaneous bilateral breast reconstruction with ms\u2010TRAM and DIEP flaps. Intraoperatively, a venous congestion of the DIEP flap, which was connected to the left cranial internal mammary vessels, appeared. In the absence of sufficient ipsilateral venous recipient vessels, we performed a salvage procedure requiring a 15\u2009cm small saphenous vein graft and presternal subcutaneous tunneling. The flap vein was anastomosed end\u2010to\u2010end with the contralateral caudal internal mammary vein using a coupler system. The postoperative course was uneventful and both flaps survived. We describe the cross\u2010over venous emergency bypass as a useful tool in unexpected venous thrombosis during bilateral free flap breast reconstruction.<\/jats:p>","DOI":"10.1002\/micr.30423","type":"journal-article","created":{"date-parts":[[2019,1,29]],"date-time":"2019-01-29T05:27:07Z","timestamp":1548739627000},"page":"74-78","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Successful free flap salvage upon venous congestion in bilateral breast reconstruction using a venous cross\u2010over bypass: A case report"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1904-5925","authenticated-orcid":false,"given":"Dominik","family":"Steiner","sequence":"first","affiliation":[{"name":"Department of Plastic and Hand Surgery University Hospital of Erlangen, Friedrich\u2010Alexander\u2010University Erlangen\u2010N\u00fcrnberg (FAU)  Erlangen 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