Can DIEP Reconstuction Be Done with a BMI of 22? (photo)

Question

I am BRCA + and am scheduled for prophylatic mastectomy with implant reconstruction in November. Recently, my sister consulted with a PS who does DIEP. My sister is 10lbs heavier than I but is choosing to do DIEP reconstruction. I am 5' 2" and weigh 122lbs. I have had 3 c-sections (horizontal) and a hysterectomy. I would like to know if I would be a candidate for DIEP and what size breasts I might be after DIEP. The soonest I can consult with DIEP PS is 12/10, after my scheduled surgery.

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  A DIEP flap is an option for nearly every woman following a mastectomy.  Size alone does not prohibit the ability to perform a DIEP flap, but it will limit the size.  However, following the procedure, various options are available to augment the reconstructed breast including fat grafting and possibly an implant.Microsurgical perforator flaps (such as the DIEP flap and SGAP/IGAP flap) are the newest and most-innovative procedures in breast reconstruction today.  As these are muscle-sparing flaps, the pain, morbidity, and complications such as those above, of these procedures are much less.  They are highly-complex procedures that few plastic surgeons performed and consult with one who is well-versed, trained, and skilled in these procedures if you are interested.   Hope that this helps!  Best wishes!

Christopher Pannucci, MD, MS · Answer

Hi BRACpositive,
Based on the photos, a DIEP would definitely be possible. The DIEP flap repurposes the excess lower abdominal skin and fat, from the bellybutton to the pubic hairline, with a blood supply to reconstruct and replace the missing volume of the breast. While the photos make it difficult to tell whether your excess in the lower abdominal region is excess skin and subcutaneous tissue versus lower abdominal bulge versus both, based on your baseline breast size it certainly appears that you have sufficient volume to make a reasonably sized breast with DIEP.
I would suggest meeting with a qualified board certified plastic surgeon who regularly performs DIEP flaps to discuss your best options.
I hope this helps
Sincerely,Christopher Pannucci, MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

J. Jason Wendel, MD, FACS · Answer

Thank you for your question and the photos.

	From the pictures you have shown it does appear that you have enough tissue to reconstruct a modest B cup for reconstruction with the DIEP flap.  You will need to see a plastic surgeon who does this procedure for a full consultation first.

	To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.  I hope this helps.

Aldona J. Spiegel, MD · Answer

Than you for including your photos which are very helpful. Yes, you are definitely a candidate for DIEP flap reconstruction. You have some abdominal laxity after your pregnancies, and adequate tummy volume to give you a close match to your present breast size.

Paul Gill, MD · Answer

Thanks for sharing your photos.   You are a great candidate for Bilateral DIEP Breast Reconstruction.  You can expect the same size range which you are currently.  

	I would strongly recommend consultation with a plastic surgeon prior to your mastectomy surgery.   By finding a breast surgeon and reconstructive plastic surgeon who have experience and work frequently together, you can obtain an excellent aesthetic result during your procedure by combining skin and nipple preservation with scar location in the appropriate patients.

	I wish you a safe recovery.

Robert Whitfield, MD · Answer

You are a DIEP flap candidate.  You need to be seen an examined by a surgeon who performs DIEP flaps.  You should not have to wait till December.  Any decrease in you current size and shape after you DIEP surgery can be improved with fat grafting. Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques. If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+

Darryl J. Blinski, MD · Answer

Yes, microsurgery breast reconstruction can be done in these circumstances. Best to obtain ONLY IN PERSON evaluations from boarded PSs that do this microsurgery.

C. Bob Basu, MD, MPH, FACS · Answer

Not sure why you have to wait until December after your surgery for a consultation for DIEP Flap breast reconstruction.  Based on your photos alone, it appears that you would likely be a candidate for DIEP flap breast reconstruction.   However, based on the photos, for a bilateral breast reconstruction, you likely only have enough tissue for a B or small C cup in each breast.  Of course, a formal physical examination would be required to make any recommendations.   My suggestion is for you to consult with a board certified PS *before* your bilateral prophylactic mastectomy to develop an immediate breast reconstruction plan.  Remember, your insurance company should allow a visit to an out of state DIEP flap surgeon for a consultation to learn more about your options should there not be a DIEP flap provider in your area.  Wishing you all the best.

	Dr. Basu

	Houston, TX

Steven Wallach, MD · Answer

Solely based upon your photos, you may be a good candidate if you want smallish breasts.  An exam in person is really key.  Good luck.

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