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Possible to Do Full Tummy Tuck While Doing Diep Flap Procedure?

I understand that the diep flap benefit of a real 'tummy tuck' is not covered by insurance. Is it reasonable to ask for the cost of a full tummy tuck (sewing together muscles, etc.) while the surgeon is performing a diep flap procedure? My surgeon seems very reluctant to even discuss outlying procedures such as abdomioplasty and liposuction, which I believe are both necessary to achieve the best final results. If I'm willing to pay for these procedures out of pocket, I don't know why my surgeon won't discuss them. Any insight appreciated.

Doctor Answers (8)

Breast reconstruction

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Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.

If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+


Austin Plastic Surgeon
5.0 out of 5 stars 7 reviews

Diep flap and abdominoplaty

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It is interesting that your surgeon wont discuss this issue with you.  I am sure the information would make you more comfortable.  Did he say he wont do it or he just wont discuss it? 

Removing the excess skin an fat in a diep flap will give you a improved abdominal contour.  It will provide many of the changes you would expect from an abdominoplasty.  Some women can get extra muscle tightening at the time of surgery.


The surgery is complex.  Perhaps the surgeon did not want to create aesthetic expectations that he could not be sure could be achieved safely during the complex surgery.  Perhaps he wanted to keep the whole process focused on the important issue of reconstructing the breast.

Adam Bryce Weinfeld, MD
Austin Plastic Surgeon
5.0 out of 5 stars 31 reviews

Full Tummy Tuck with DIEP Flap Breast Reconstruction

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A tummy tuck consists of removal of excess skin and fatty tissue, followed by tightening of the weakend rectus muscles.    

 

In my DIEP Flap patients, I frequently plicate the abdominal muscle, but do not recommend liposuction or an extremely tight abdominal closure if the reconstruction is being performed in the immediate setting of the mastectomy.  Why?  With breast cancer, your body is immunosuppressed.  You are at a much higher likelihood of delayed wound healing or infection, compared to your healthy state.   In addition, you may require chemotherapy after surgery and I do not want to risk a wound healing issue that may delay your cancer treatment.

 

You can always come back to fight another day, but our main goal is a safe and predictable outcome/recovery.

Paul S. Gill, MD
Houston Plastic Surgeon
5.0 out of 5 stars 34 reviews

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Stages

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For your own safety to ensure that the combined surgery is at unsafe length of time, you will be better off completing DIEP Flap surgery before planning and proceeding with the tummy tuck and liposuction.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 14 reviews

It is possible to do rectus plication with DIEP flap donor site closure for a full abdominoplasty result

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When the DIEP flap (deep inferior epigastric artery perforator flap) is used for microsurgical breast reconstruction, usually a small split is made in the muscle fascia (thick layer of collagen over top of the rectus abdominis muscles) to dissect out the blood vessels used for transplantation of skin and fat from the tummy to the breast.

Usually, the fascial split is simply closed, and the overlying anterior abdominal wall (sheet of skin and fat over the muscles of the trunk) is pulled tighter and closed, resulting in a tummy tuck scar.

It IS possible to perform rectus fascial plication (corsetting of the rectus abdominis muscles of the abdominal wall towards each other in the midline AT THE TIME of DIEP flap donor site closure.

However, doing so may change the pressures inside the abdominal cavity (i.e. on the stomach, intestines, diaphragm, etc) and may increase the risk of complications to the flap circulation in the short term. The worst case scenario would be to perform cosmetic steps during surgery and to lose the flap altogether!

Performing a full tummy tuck closure with the DIEP flap is something I HAVE performed successfully on a number of occasions, but patients must be very carefully selected and we would all have to be willing to accept an increased risk for complications.

I am currently reviewing my results on this combined procedure and will be presenting my work at upcoming meetings and in the form of a scientific paper, to be published on my website.

Often, the best solution is the simplest. On the day of your DIEP flap, it is usually best to focus only on microsurgical success. "Touch-ups" can be done any time in the future, including liposuction contouring of the abdomen (done in most of my patients) together with their nipple and areolar reconstruction, and/or rectus fascial plication, if needed.

Karen M. Horton, MD
San Francisco Plastic Surgeon
4.0 out of 5 stars 4 reviews

Combining cosmetic surgery with breast reconstruction

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Hello - I see your point, but as someone who does DIEP flaps the procedure can take a very long time. Any added surgery may increase the time and stress of the case for the surgeons and staff. The best thing for your to do would be to get your DIEP flaps, recover, and then get liposuction and tightening of your abdominal muscles at a later date. This will allow your body to recover and allow your surgeon to fully concentrate on the cosmetic nature of your surgery. Good luck!

Jeffrey E. Schreiber, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 66 reviews

Combining a Microsurgical Breast Reconstruction (DIEP flap) with Tummy Tuck and Liposuction

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NOT a good idea. Doing to much surgery at one setting can cause very serious complications and even death. Please reconsider this action as too dangerous.

From MIAMI Dr. B

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Combining a Microsurgical Breast Reconstruction (DIEP flap) with Tummy Tuck and Liposuction

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For the benefit of the readers unfamiliar with Breast Reconstruction after mastectomy, a DIEP flap uses a removed (IE free) transverse segment of the lower tummy skin and fat (without using the underlying muscle like a TRAM flap) and builds the breast with it AFTER the artery and vein of that segment are joined under the microscope to either a chest or an arm pit artery and vein. In the best of hands, the operation takes several hours.

Although the tummy muscles could be tightened through the same incision, most Plastic surgeons would find the DIEP operation sufficiently tiring that many would prefer not to subject you to the additional complications of a tummy tuck and liposuction.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 58 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.