Bilat DIEP Flaps or Brava+fat Graft to Reconstruct A Cups?

51 yo non-smoking ft student wi 9 mm carcinoma rt breast, no nodes involved and have elected to do bilat mastectomies due to family hx. Used to have an athletic build, now mildly obese mesomorph getting back into shape. The PS at my university does lots of DIEPs, but I worry about recovering from 16 hrs of surg wi classes starting Aug 13. I'm wondering if repeated BRAVA+ scant fat grafts is better for me? Opinions on long term issues? If fat necroses or forms nodules, options to repair? thanks!

Doctor Answers 4

DIEP flap vs. Fat Grafting with BRAVA

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The advantage of the DIEP flap for you is that it is one operation and one recovery to create the necessary volume of the breast.   1 or 2 more outpatient procedures may be necessary to create improved symmetry and shape or to reconstruct the nipples.


Fat Grafting is outpatient and has less recovery.   The downside is that this procedure requires several fat grafting sessions to obtain the volume of a diep flap. 


DIEP flap probably has more short term risk, but less longterm risk and downtime.   Fat Grafting has less short term risk, but more longterm risk and downtime.


Depending on your institution and surgeon experience, a bilateral DIEP flap does not necessarily take 16 hours.    We perform this operation weekly in 6-8 hours routinely.   It takes approximately 2 weeks to do basic Activities of Daily Living and 4-6 weeks to resume all normal activities.


I wish you a safe and healthy recovery!!!


Dr. Gill

Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

The bilateral DIEP flap can be an excellent option and completed in less than 10 hours in skilled hands.

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The bilateral DIEP flap can be an excellent option and completed in 10 hours in skilled hands. I do a large number of them in Nashville, TN. The recovery can be better than expected because the muscle is spared.  I recommend an abdominal binder for six weeks and no lifting >10 pounds for 8 weeks.

Fat transfer is also an option be it can take months and many fat grafting sessions.

You may also opt for delayed reconstruction and wait for a time when you can have the reconstruction that you want.

The ultimate decision is up to you.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Fat graft only breast recon vs DIEPs

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The recovery from bilateral DIEP flaps will take longer and be more difficult than a series of fat grafts.  The advantage of DIEP is you get a larger amount of tissue to work with right away which helps with the best contours after revisions.  The down side is a large incision and scar on the lower abdomen (unless you also want a tummy tuck).  Fat grafting will be a slower process to get you volume, but each surgery will be easier on you.

Leif Rogers, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 26 reviews

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All depends on your expectation and amount of tissue left

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DIEP flap can give you more predictable size if you have enough donor site over lower abdomen. The DIEP should not take 16 hr. I been doing DIEP for 13 years(new Orleans was where it started by Dr.Allen) and the average time for bilateral Diep is 5-6 hrs in combination with mastectomies. I offer Brava and fat grafting and works better if you have some tissue to start with. 

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 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.