Is It Possible to Do a Diep Flap After a Mini Tummy Tuck?

The perforator flap option is effectively eliminated after a tummy tuck as the tissues supplied by the perforating vessels has been elevated and detached. Other options for breast reconstruction exist, including implant based options, more exotic free flaps like TUG flaps, and pedicled flap options like the latissimus flap.

The DIEP flap gets it's blood supply from small blood vessels that may be injured by the minituck. The traditional way to make sure that these are intact is to do a traditional angiogram but this is an invasive and costly procedure. A simpler way is a CT angiogram. The DIEP flap is a technically demanding operation that preserves the abdominal muscles the best, among all the techniques used for breast reconstruction. During the surgery, this can be confirmed by using the SPY laser system that is available in some medical centers. Your best bet is to discuss this thoroughly with a well trained plastic surgeon who is very familiar with this and does DIEP flaps on a regular basis.

Although previous tummy tuck or mini-tummy tuck surgery was previously considered a contraindication to DIEP flap surgery, it is no longer always the case. Tummy tuck surgery will disrupts some, but not necessarily all of the blood vessels which can be used for a DIEP flap. With preoperative blood vessel imaging, for example with an MRI, it is possible to figure out precisely whether or not a DIEP flap is possible. I have done DIEP flaps in patient who have previously had mini-abdominoplasty surgery, and have reported such cases in peer-reviewed medical journals. 

The following is an excerpt from the Journal of Reconstructive Microsurgery ("Anatomic Imaging of Abdominal Perforator Flaps without Ionizing Radiation: Seeing Is Believing with Magnetic Resonance Imaging Angiography"), published in 2010:

In select cases, the assurance of the presence of suitable perforator vessels may allow a patient with a history of abdominal surgery, which would have previ- ously been considered a contraindication, to undergo an abdominal perforator flap procedure.20 As a dramatic example, we present a patient imaged preoperatively with CTA. The patient had a history of central abdomi- nal liposuction and a miniabdominoplasty 18 years ago, but desired the abdomen as the donor site for breast reconstruction. Figure 5 demonstrates a single perforator identified at 4.6 cm inferior and 5.2 cm lateral to the umbilicus. A DIEP flap was planned and successfully transferred based upon this vessel. Traditionally, without preoperative imaging, this patient would never have been a candidate for DIEP flap breast reconstruction.

A mini tummy tuck is a safe and effective procedure that can create a more contoured abdomen, a tight waist and a beautiful figure.

After a patient has received a mini tummy tuck, the anatomy of the lower abdomen has been altered. Because of this alteration, it is not possible to perform a DIEP flap after a tummy tuck.
 

Performing a DIEP flap requires that the blood supply to the falp was not injured during elevation. More than likely it was damaged, but only the surgeon would know for sure.  Othere studies that are more invasive can determine this as well.

Regarding: "Is It Possible to Do a DIEP Flap After a Mini Tummy Tuck?"

For the benefit of the RealSelf readership who does not know, a DIEP flap is the use of the lower tummy skin supplied by PERFORATING (The "P" in DIEP) branches of the Deep Inferior Epigastric Artery. Instead of taking a piece of the lower 6 pack muscle to capture the vessel, the DIEP flap uses careful dissection based on angiography (radiological studies documenting location and patters of blood vessels) to lift the skin supplied by these perforating vessels coming out of the DIE artery.

The problem is that in a Full Tummy Tuck and in the vast majority of Mini-Tummy Tuck operations, the DIE needs to be divided, thereby, making its perforators no longer reliable for use in the DIEP flap.

An angiographic study is always carried out before such an operation to assure the surgeons the vessels are there and it is MORE than ever required in a case of a previous Tummy Tuck.

Dr. Peter Aldea
 

In most instances the blood supply is compromised espeically if rectus repair is performed but duplex scan, MRA, or traditional angio will be best way to determine if it is possible.

The only way to be absolutely sure is an angiogram procedure to see if the DIEArtery is still there. Otherwise I believe blindly trying this operation will lead to a failure. From MIAMI DR. B