Full tummy tuck with DIEP Flap (preventative mastectomy)?

Question

I'm BRCA1+, 2 months post-laparoscopic hysterectomy and preparing for a preventative mastectomy. After consulting with a leading breast surgeon in my area, I'm heavily leaning toward DIEP flap but was too nervous to ask about a tummy tuck at the time. The fat would be taken from my stomach, so could I have a complete TT at the same time? After 2 kids and an old back injury, it's been near impossible for me to lose the weight in my midsection. What steps would I need to take? Thank you!

Farbod Esmailian, MD · Answer

The DIEP procedure involves removal of the skin and fat in the abdominal area.  So in a way it will be a tummy tuck but one thing you must remember you are having this procedure to reconstruct your breast not contour your abdomen.  This is a difference there and the priorities are different.  Which means that the incision placement may not be as low as you would want it and would get in if you have a formal tummy tuck.  There may not be muscle plication as that is not part of a DIEP procedure and this would need to be discussed (financially and logistically).I would discuss the specifics with your surgeon and make certain they understand your expectations.Good luck on your procedure.Hope that helps.

Kenneth Hughes, MD · Answer

By taking tissue from your lower abdominal area, the DIEP flap technique provides body contouring results similar to a TT. the DIEP flap preserves the abdominal muscles and allows you to maintain strength and muscle function in your abdomen. This also leads to a less painful and faster recovery. The abdominal scar will be below the bikini line and run from hip to hip.

Thomas William Horn, MD · Answer

DIEP Flap Breast Reconstruction is an excellent option for many women who are going through reconstruction due to breast cancer or who are BRCA Positive. DIEP flap surgery in many cases gives women the option of reconstructing the breast without the use of implants.  Abdominal tissue is used in the reconstruction of the breast and in turn the patient  will have the appearance of a tummy tuck. 
DIEP Flap surgery is a highly specialized procedure which uses a free flap technique transferring abdominal tissue and blood vessels to the breast area. I have my potential patients undergo specific testing to determine if they would be a good candidate with both enough tissue to transfer as well as a healthy blood supply to keep the flap viable once it is transferred.
The final outcome for the patient would be a naturally reconstructed breast as well as results similar to a tummy tuck.

Matthew A. DelMauro, MD, FACS · Answer

Hello! Thank you for your question. When a plastic surgeon performs a procedure using a DIEP flap, the plastic surgeon takes tissue from your abdomen. This may sound like a tummy tuck, but it differs in some key ways. First, the location of the tissue that is removed as part of the DIEP flap is not exactly the same as the tissue that is removed for a tummy tuck. This results in a slightly different location of the final abdominal scar. In general, tummy tucks results in a lower scar than DIEP flap procedures. Second, a tummy tuck involves tightening your abdominal wall to narrow your waistline and get rid of central abdominal bulges. While some plastic surgeons do this during DIEP flap procedures, many do not.
It is also important to keep in mind that neither a tummy tuck nor a DIEP flap procedure are weight loss procedures. Certainly, these surgeries improve the overall appearance of your mid-section. But they should not be thought of as replacements for exercise and diet. 
I hope I have been able to answer your questions! Best of luck!
Matthew A. DelMauro, M.D.

Lyndsey Highton, BMBCh, MA, FRCS(Plast) · Answer

You don’t need to worry - a DIEP flap procedure essentially includes a tummy tuck. The tissue excised from your lower abdomen is used as ‘free flaps’ for breast reconstruction. The upper abdominal flap is undermined and repaired, usually with midline muscle plication, exactly as with a tummy tuck. The DIEP flap is a great procedure for natural tissue breast reconstruction and usually leads to a big improvement in the abdominal donor site. I am sure your surgeon will be happy to explain further. Good luck with you treatment!

Full tummy tuck with DIEP Flap (preventative mastectomy)?

Answers (5)

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