Breast Reconstruction: Q&A

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Is Changing Type of Procedure During Operation a Usual Occurrence? Have Diep 1 Side and Tram on Other Side,

diep side is the radiated side,also side with gram negative pseudomnas, been on Cipro 3 wks, this is the breast that has shrunk and has abnormal tissue. Actually looks to me like partial flap failure, but the doctor not even considering. Says just wait.......

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5 Doctor Answers | Asked by sinbad1 in south jersey

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Partial DIEP flap loss on radiated side common.

It is well known that all types of flaps, free or otherwise, have more complications on the radiated side with an increase in partial flap loss. I would need more information and some photos before I could give you definitive advice, but it may be that debridement is needed.

Changing plans during surgery???

It is not uncommon to change plans from a diep to muscle sparing free tram depending on the quality and number of perforators found at the time of surgery. The downside of free tram vs diep is obviously the morbidity placed on the abdominal wall. However, you have to weigh this vs your chances of achieving a successful breast reconstruction. I have done this long enough to always leave my ego at the door, in other words I will switch operative plans in order to maximize the... more

Breast reconstruction choices

The surgical plan can sometimes change in the operating room based upon your anatomy. I always tell patients preoperatively about all kinds of flaps especially with these types of cases that depending upon the anatomy and how things progress flap decisions may have to be altered to provide the safest and best results possible.

Steven Wallach, MD

13 reviews

Manhattan Plastic Surgeon

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I'm sorry to hear that you are experiencing problems with your DIEP flap reoconstruction on your radiated side. If you are experiencing an infection after autologous reconstruction and antibiotics did not successful treat your infeciton, and you are stating that your flap has "shrunk", I would be concerned about partial flap necrosis (where your reconstructed tissue is not getting enough blood supply. In light of your active infection, you may need an intervention to... more

DIEP on ONe Side and a TRAM on the other

Obviously I am sorry that you are having an issue on the DIEP side after surgery and post op radiation if I am reading this post correctly. The differences of DIEP and TRAM that are done using microsurgery are that the muscle is left in place in a DIEP. Varying amounts of muscle are incorporated into free TRAMs and muscle sparing free TRAMs. Pedicle TRAM flap rely on much of the muscle. Usually only the leaving a small amount. It sounds like you being treated... more

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Breast Reconstruction: Q&A

Is Changing Type of Procedure During Operation a Usual Occurrence? Have Diep 1 Side and Tram on Other Side,