Breast reconstruction (take 2), is the DIEP Flap procedure the most appropriate next step? (Photos)

Question

DIEP Flap procedure was suggested as next step History: - Double mastectomy, reconstruction with expander - Expanders replaced with full implants - Planned: Fat transfer after healing (not performed)   Issues:  1. Thin skin lack of blood flow 2. Visible implant rippling   Questions: 1. Is the DIEP Flap procedure the most appropriate next step? 2. Are there alternative options to consider?

Gary M. Horndeski, MD · Answer

If you want to continue using implants then perhaps you would benefit from a lift, revision of your previous reconstruction and placement of implants retro-pectoral, if they are in front of the muscle. Also, the implants can be removed and fat transfers can be done and then the implants replaced. If you do not want to continue with implants then a DIEP flap is a valid alternative.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ram Kalus, MD, FACS · Answer

Thanks for your question and photos. An examination in person and understanding of your current implants is necessary to provide you with relevant recommendations. The rippling can be helped with a higher cohesivity implant, or possibly Motiva. The addition of ADM as a thickening layer over your implant can also help. Additional fat grafting may also be helpful.

A DIEP is always an option but a big operation with a significant recovery. I would exhaust other possibilities first. If you have confidence in your plastic surgeon, discuss all of your options. If you feel a second opinion is in order, select an experienced board certified plastic surgeon whose aesthetics and reviews resonate with you. Best of luck to you.

Breast reconstruction (take 2), is the DIEP Flap procedure the most appropriate next step? (Photos)

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