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Tram or DIEP Flap Using Stomach Apron for Breasts After Weight Loss?

asked 2 years ago by StarWish624 in Southern California, USA
Latest answer by Steven Wallach, MD
Question viewed 1,140 times
Tags: stomach, excess skin, weight loss, DIEP, massive weight loss, TRAM, tramflap

I had breast cancer (Chemo./Rads.), and am awaiting reconstruction. I have lost 175+ pounds, and have a large stomach apron of excess skin. I was hoping that some of this skin could be used for the breast, but my plastic surgeon said that the skin is unusable. Is this true? I hoped that a Tram/DIEP flap would let me get a tummy tuck, too, but the P. S. wants to do a Lattismus Dorsi flap instead. Also, the P. S. said that the other breast reduction surgery would result in loss of nipple sensation (formerly large breast, now flat). Help?

7 answers to Tram or DIEP Flap Using Stomach Apron for Breasts After Weight Loss?

+2

DIEP or TRAM reconstruction

Most women are able to use excess skin and fatty tissue reconstruct a breast following mastectomy. I have found that very few women who have excess tissue- even if it is stretched out- are not candidates to use this tissue for breast reconstruction. Obviously, there may be exceptions to this rule, but without seeing and examining you, it would be difficult to say for certain. DIEP vs. TRAM Natural-tissue breast reconstruction methods use excess tissue from a woman’s own... more
David Greenspun, MD, MSc

New York Plastic Surgeon

www.davidgreenspunmd.com

+2

Pannus for a TRAM flap?

Your doctor is right - you can't use a pannus of hanging skin after weight loss as if it were a TRAM or DIEP flap. The blood flow isn't safe for it to reliably survive. A latiss flap is a good choice becasue of your XRT and you could have a tummy tuck later and use some of the skin for an areola graft. Numbness may happen from any breast reduction and lift.
Richard P. Rand, MD, FACS

Seattle Plastic Surgeon
+1

Reconstreuction after massive weight loss

With an apron of skin and fat hanging over your belly, this tissue is not ideal for reconstruction and may result in severe complications.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Can a DIEP or TRAM flap be done in a massive weight loss patient?

It depends on the size of your pannus and the quality of fat/tissue remaining after your weight loss.  It is impossible to make any recommendations without an examination.  Having said that, I do have experience successfully performing DIEP or TRAM surgery on patients who have lost a significantly amount of weight.  However, in these cases: - patients were very healthy (no medical problems- no comorbidities), - although they had a small pannus, they had a good... more
C. Bob Basu, MD

Houston Plastic Surgeon

www.basuplasticsurgery.com

+1

First surgeon on the right tract

I tend to agree with your original PS. If you have a large pannus then it is usually primarily skin and would give little volume to the breast, even if it blood flow was adequate. You do need healthy tissue to cover an implant in radiated field and the Lat Flap is the best choice. If you have lost this much weight you would usually be better served with a lower body lift to get the best cosmetic result.
William E. Alison, Jr., MD

Huntsville Plastic Surgeon
+1

DIEP flap Breast Reconstruction after Massive weight Loss

I DO think that SOME of the Tummy skin COULD be used as a DIEP flap breast Reconstruction (pending a face to face examination). However, you will NOT be getting a Tummy Tuck thrown in at the expense of the insurance company. Ethically speaking, your surgeon just needs to remove the portion of the tummy skin along with its blood supply needed to build the breasts, transfer it to the breast(s), shape / cone them and join them microscopically to the blood vessels either in the chest, along the... more
Peter A. Aldea, MD

Memphis Plastic Surgeon
+1

You would be a good candidate for DIEP flap

You have excesss in lower abdomen and loss skin and fatty tissue from the breast. This a ideal situation to do DIEP flap. The advantage of the Lattismus flap is the time of surgey and faster recovery. DIEP flap involves microsurgery. You would get tummy tuck and DIEP at the same time for the breast reconstruction. I would recommened that you get a second consultation and make sure your platic surgeon offer microsurgery. The risk of nipple sensation loss is low and this can be done at the... more
Kamran Khoobehi, MD

New Orleans Plastic Surgeon

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