Breast Reconstruction: Q&A
Ask a Question
Tram or DIEP Flap Using Stomach Apron for Breasts After Weight Loss?
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?
Tags:
9 Doctor Answers |
Asked by
StarWish624
in Southern California, USA
+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
+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.
+1
Breast reconstruction following massive weight loss
There are ways to tailor the abdominal flaps in order to make the tram a useable option. I have operated on several women who have had a 100 pound weight loss. I try to tailor the breast recon in the same way as an inverted T abdominoplasty by tailoring this tissue and taking the tissue directly over the rectus muscle leaving it attached. I have plenty of tissue to fashion a breast and my patient has a nice abdominal contour afterwards. As with any breast...
more
You might also like...
Real Stories
Amazing Results! - Nashville, TN
I started the surgical process when I discovered I was BRCA2+. I chose Dr. Wendel to...
+1
Use of abdominal pannus for DIEP Flap
Prior to recommending a DIEP flap for your breast reconstruction, I would want to ensure that you Body Mass Index (BMI) is below 40. I also would want to ensure that you do not have many comorbidities, such as diabetes, hypertension, history of heart attack etc.
Based on your exam, it would be determined if your abdomen is a suitable donor site for breast reconstruction.
I often find that the technical aspects of the DIEP flap breast reconstruction are easier in...
more
+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.
+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
+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.
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
+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
Comments (0)