DIEP, is There Anything else in the Pipeline?

I am 47 and have had breast cancer twice. A lumpectomy with radiation at 31 and bilateral masectomy at 43 without reconstruction. In my opinion, the current options for reconstruction are barbaric. I am tired of wearing I'll fitting clothes and want to do something that does not require more rehab than cancer surgery and without drains. Is my wish ever going to materialize? Stage 1 both times.

Doctor Answers 6

Breast Cancer Reconstruction

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Given your history of radiation, it seems that the best option for you could be to use your own tissue (autologous) to reconstruct both breasts.  Implants and fat grafting techniques do not do as well in radiated tissues.  While there have been many advances in tissue transfer surgery to reconstruct mastectomy defects, none of them are non-surgical.  They all require the use of drains, and recovery time after a typically major surgery.  The results however can be quite dramatic and satisfying for patients who are able and interested in having the surgery.

Daytona Beach Plastic Surgeon
5.0 out of 5 stars 9 reviews

Options for delayed reconstruction with a history of radiation include the DIEP flap, latissimus dorsi flap, SGAP, SIEA, IGAP, a

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Thank you for your question.

Options for delayed reconstruction with a history of radiation include the DIEP flap, latissimus dorsi flap, SGAP, SIEA, IGAP, and TUG flaps.  All of these surgeries are involved.

If you do not wish to have surgery and do not wish to have drains, you may wear prostheses.

Fat transfer has preliminary promise but is not widely accepted yet.  Also, radiation makes it extremely difficult to get the transferred fat to live.

I'm sorry I couldn't be more help to you.

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

Breast cancer reconstruction

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All of the breast surgeries post mastectomy require invasive procedures whether you use tissue expanders and implants, or autologous tissue like a TRAM or DIEP.  Sorry. Nothing specifically in the pipeline that will replace this jsut yet.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Current options for tissue reconstruction

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I can understand your concern and hesitation with proceeding with a breast reconstruction procedure.   After going through breast cancer twice, more surgery is probably the last of your desires.  


Unfortunately, the best reconstruction for you longtime will most likely involve use of your own tissue.   It is difficult to give exact recommendations without an exam or photos to judge.  My concern is your radiation history may not mix well with implant reconstruction.


In the meantime, I would recommend that you consult with 3 board certifiied plastic surgeons with expertise in breast reconstruction to ensure you make the most educated decision.   I would also ask to speak to some of their patients, so you can hear first hand how the experience has been.


I hope this helps.


Dr. GIll

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 95 reviews

Breast reconstruction using DIEP flap, implants, fat grafting, latissimus flap

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I would recommend a consult performed with someone who is comfortable with all options.  I don't know which technique it is that bothers you the most and why.  There are several options but due to radiation treatments your response to many forms of reconstruction will be limited by your tissues and not so much the technique.

Breast Cancer Reconstruction Options

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There are many options for breast cancer reconstruction. The best results are obtained when the reconstructions are performed simultaneously and when the oncological surgeon and plastic surgeon work together. For an immediate implant + alloderm reconstruction, there is minimal down time. You will have to have the opposite breast lifted to mach the the reconstructed breast. Unfortunately, this is not an option for you. 

For delayed breast reconstruction, there are currently no new options. Some surgeons are working on stem cell and fat grafting options, but these efforts are very immature and are currently not viable options. The two best options today are either a tissue expander with alloderm and then exchanging the expander out for a silicone implant or a free tissue transfer. We are currently able to achieve excellent results with implant based reconstructions, such that they are just as good an option for those not up for the free tissue transfer (e.g. DIEP). For primary reconstructions, these results look as if patients had a breast lift (mastopexy) procedure instead of breast cancer reconstruction.

From your description, it sounds like an implant & alloderm reconstruction is a better option for you. The down side is that you will need cope with having the tissue expander serially expanded until a silicone implant can be placed.

Please consult a plastic surgeon who is well versed in breast cancer reconstruction to discuss these options in more detail. 

Perry Liu, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 5 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.