Can I Have Any Other Form of Reconstructive Surgery Following a Failed DIEP Flap?

I'm in my early 40's, I had a DIEP flap reconstruction and it failed due to a blood clot & veinous bleed & having complications and also lots of allergies I'm not sure weather I should just accept that I am unable to have further surgery in the future following cancer.

Doctor Answers 8

Can I have any other form of reconstructive surgery following a failed DIEP flap?

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Hello!  Thank you for your question.   After radiation, you have an increased rate of complications including wound problems, infections, thinning of the tissue, and decreased vascularity to the skin/tissue of the area.  The best method to reconstruct a breast following radiation therapy is with a flap.  The flap, which is skin, fat, and sometimes muscle, will serve to bring in healthy, well-vascularized tissue to the chest/breast area that will significantly ameliorate the radiation issues compounding the problem.  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.  

There are many options to breast reconstruction including implant-based and flap-based procedures.  The complication rate with implants following radiation is reported as high as 60-70% in some studies.  Flap reconstruction is usually recommended, but there are several centers who perform implants following radiation with great success and results.  I typically prefer flaps, such as the DIEP flap.  Other flaps are the conventional TRAM, latissimus flap, SGAP/IGAP, and, TUG.  You would be a candidate for the latissimus flap, SGAP/IGAP, and TUG flaps.  Also, if there are no contraindications, implant-based breast reconstruction should still be an option as well.  

You are a candidate for other procedures, if you are willing to continue with your journey for a reconstructed breast.  Flaps such as those above, including others, are available.  The decision to continue with this will be your decision and what you are willing to go through.  There are risks and benefits with everything that we do in Surgery - discuss the various options with a board certified plastic surgeon who will educate you on all of the options and help you to decided if breast reconstruction or which procedure will be best for you.  Hope that this helps and best wishes!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Breast reconstruction

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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+

Salvage after failed DIEP flap

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Loss of a free flap does not preclude salvage with another free flap if natural tissue reconstruction is your preference. GAP flap from the buttock and TUG flap from the inner thigh may be options depending on your body shape. Last week I operated upon a woman who had lost her flap 3 months ago and I used an alternative free flap successfully. If those donor sites are not available, then a latissimus flap with expander is a better option than tissue expander alone. Hope is not lost, stay with it and find a surgeon that is as motivated as you are.

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Breast reconstruction after failed DIEP falp surgery

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Sorry that the DIEP, which is a great option, falied.  No failure is final.  Start with the surgeons you already know.  My guess if they do many DIEP flaps that they handle less complicated methods of reconstruction.  Good luck. 

Craig Harrison, MD, PA
Tyler Plastic Surgeon

Latissimus flap and tissue expander are the two easiest options for a failed DIEP flap

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The DIEP flap, though very good, relies on a small vessel to carry a lot of skin.  The latissimus dorsi flap is just the opposite: a large muscle carrying a small amount of skin.  The latissimus flap is therefore very reliable.  In all likelihood, you would need an implant to shape the flap.  That flap is the best if your other breast is a C cup or larger, or if you have had radiation.

If your other breast is an A or B cup and you want to match that size, you can go with a tissue expander as long as you have not had radiation.

Find an experienced plastic surgeon whom you like.  You need great rapport, especially with the issues you have already had.  Good luck.

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon

You have multiple options

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I am sorry about the loss of flap. You can have TUG flap from groin or thigh flap for Autologus breat reconstruction. The other option is tissue expansion and implant reconstruction. The third option is fat grafting in multiple sessions in combination with BRAVO external expansion. I would suggest consultation in person or over Internet to review your pictures and goals.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Breast reconstruction options after unsuccessful DIEP flap

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For those who aren't familiar, a DIEP flap is a procedure for breast reconstruction in which a mass of tissue is taken from the lower abdomen and transferred to the breast where blood vessels are reconnected using microsurgery; if the connections clot then the whole flap is lost. Options at this point depend entirely on the individual circumstance. If there has not been radiation treatment then a tissue expander and implant would be the easiest route.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Breast Reconstruction

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In general you still have multiple options in breast reconstruction.Not knowing your medical history, you stilll have the option

tissue expander and implant

Latismus dorsi flap with or without the implant, depending on the breast size and skin available

Another frr flap from the Gluteus muscle

Cosult an exerienced plastic surgeon and after complete history and exam they can discuss all the options available for you and the optimal timing of the reconstruction.

Samir Shureih, MD
Baltimore Plastic Surgeon

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.