Ask the Expert

Answered By:


Maurice Nahabedian, MD, FACS

Professor and Vice Chairman
Department of Plastic Surgery
Georgetown University Hospital,
Washington, DC

Q:

I have had a mastectomy and want to have reconstructive breast surgery soon. I've heard about a new procedure called the DIEP flap and want to know if it would be a good option for me.

A: 

There are many factors for you and your doctor to consider when deciding on a type of reconstructive surgery, including your overall health and any other medical conditions, whether or not you smoke, your overall size, the size and shape of your other breast and your past surgical history.

There are two main types of breast reconstruction available: implant reconstruction, in which silicone or saline implants are inserted into the breast area, and autologous reconstruction, in which a surgeon creates a new breast using fat, tissue and, usually, muscle from another part of your body. Most flap procedures use tissue from your back or abdomen, although some use tissue from your thigh or buttocks.

The deep inferior epigastric perforator (DIEP) flap procedure is one type of autologous reconstruction. It does not remove or move any abdominal muscle, which means that recovery is usually faster and complications are usually fewer than with traditional flap surgery. Because DIEP surgery removes excess tissue from your abdomen to reconstruct your breast, you usually get the appearance of a tummy tuck (tighter skin over the abdomen).  

To be a candidate for DIEP flap surgery, you must have an adequate supply of blood to the skin and fatty tissue so no muscle needs to be taken and muscle function is maintained. This and other flap procedures often aren't recommended for thin women; however, some thin women may still be candidates for DIEP flap reconstruction.

Although, most women are good candidates for this type of reconstruction, not all are. In general, women who smoke or who have diabetes or connective tissue or blood vessel diseases are not good candidates for an autologous procedure because these conditions can affect blood circulation. A healthy blood supply to the new breast is critical to the success of the surgery. Also, women who are extremely overweight or who have had multiple abdominal surgeries may not be good candidates.

All flap reconstructions carry certain risks, including the loss of blood supply to the new breast, which could lead to infection and/or the loss of some or all of the breast tissue. Additionally, recovery from autologous procedures is more extensive than from implants. Typical hospitalizations are three to four days, although in some cases up to a week may be required. This is followed by several week of home recovery.  

A consultation with a plastic surgeon is necessary to assess what's best for you. Remember that the DIEP procedure is still relatively new and difficult to perform, so it is important to find an experienced surgeon if you go that route.