Which flap revision is for me? (Photo)

5/15 bilateral mastectomy expanders Replaced in July with 450 due to infection cc implants then all along emfection dr cut away infection in his sergical office every few wks. Oct a whole broke on the left side right healed. Dr removed both replaced w 350 cc then same thing for following weeks with cutting away infection until there was no more skin. May 2017 removal of implants. Now healed what do I do ? Dr referred to a new ps says can do flap from the Stomache I'm scared of hernia

Doctor Answers 4

DIEP flap after failed breast reconstruction with implants.

Thanks for your question.  You are experiencing complication related to implant reconstruction.  DIEP flap Reconstruction is an optimal solution to your complication.  It uses the abdominal fat for the reconstruction of the breast without the use of muscles.  As long as there is enough abdominal fat to harvest adequate sized flaps, this is a great option for you.  Good luck.

New Orleans Plastic Surgeon
4.9 out of 5 stars 28 reviews

DIEP flap reconstruction

I am sorry about your experience post mastectomy. You would get better results with autologous tissue breast reconstruction. The best option is using your lower abdominal tissue without using the muscle( Deep Inferior Perforator Flap) to avoid wreaking the abdominal muscle. The other option is to use the tissue from inner thigh (PAP) flap.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

You have options!

I agree with Dr Whitfield, but I would add a few more options.  You could have another attempt at implant reconstruction if you have not had radiation, but it would be risky and the outcome might not be so good.  You could undergo bilateral latissimus dorsi flaps and if you didn't have enough tissue you could place an expander or implant under the flap.  There are a variety of abdominal flaps (pedicle TRAM, free TRAM, muscle-sparing TRAM, DIEP, SIEA) that would work if you have enough abdominal tissue, and then there are a variety of "secondary" flaps from the buttocks and thigh.  You should seek consultation with someone experienced in all of these techniques, so they can assess your body and determine the best plan.  Good luck!

Eric G. Halvorson, MD
Asheville Plastic Surgeon
5.0 out of 5 stars 3 reviews

Breast reconstruction revision with DIEP flap or PAP flap

Given your history of infection you are being referred for reconstruction with your own tissues.  The most common source is your lower abdomen.  The concern of a lower abdominal bulge does exist but is low (0.7% to 5%).  The next most common procedure uses the inner thigh tissue in the form of a PAP or TUG flap.  After that the upper buttock tissue can be used in the form of an SGAP flap.

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.