Is it possible to get a double mastectomy diep reconstruction and lipo at the same time?

Hi, thank you for your question.Although it is technically possible to do this, it is not recommended to combine these procedures due to the risk of complications from extended anesthesia time and fluid shifts that may occur. Consult with your board certified plastic surgeon to see what options you have to address your concerns.I hope this helps. Best of luck! 

Performing liposuction during the DIEP flap procedure is not standard or recommended. Both the DIEP flap procedure and liposuction increase your risk for blood clots, or venous thromboembolism (VTE). Performing them together would increase your risk too much. It is important to note that abdominal liposuction is a common adjunct procedure during a secondary operation in which fat is transferred from the abdomen, flanks, and thighs to the breast. The fat grafting procedure is utilized typically to fix contour abnormalities on the breast.

The most common reasons why liposuction is not combined with mastectomy and DIEP flap breast reconstruction are the following: 1. Time: Combined double mastectomy and immediate DIEP flap reconstruction time consuming and complex, often taking 5-8 hours to complete. Additional elective procedures may not be appropriate from a safety perspective.2. Fat as a resource: Flank liposuction and fat grafting is a common strategy for improving the results of DIEP flap breast reconstruction in the months following surgery. These procedures are generally covered by insurance.3. Cost: Elective liposuction for cosmetic reasons is NOT covered by most insurance plans. So patients typically have to pay out of pocket if and when liposuction is performed (except in the context of fat grafting, see above).

A double mastectomy and DIEP reconstruction is a long day in the operating room...anywhere from 7 to 12 hours, with a few days in the hospital afterwards. These operations go hand-in-hand, and there is a huge psychological benefit to waking up with your breast reconstruction completed.
I am assuming your are asking about liposuction for cosmetic purposes, perhaps to smooth out the transition from the abdominal based donor site to the flanks. I wouldn't advise this at the time of DIEP reconstruction for two reasons. First, there is a straight line relationship between time spent in the OR and risk for complications...and so minimizing your OR time in the setting of a big operation would be ideal. In addition, many women need fat grafting to the reconstructed breasts as a Stage II reconstructive procedure, and there would be no reason to throw that fat away at Stage I when it could be useful in Stage II.
In summary...it is technically possible to add liposuction during a DIEP, but I don't think it is in your best interest for either your reconstructive timeline/pathway, or for patient safety.
Best,Chris Pannucci MD Spokane WA

With DIEP breast reconstruction there are stages. Doing liposuction at a later stage (ie nipple reconstruction, fat grafting) may be a better option because it could add increase risk of longer anesthesia time, decreased blood flow to the tummy tissue or wound healing issue. With doing the procedure at a later stage it may be part of the fat grafting.

the liposuction adds an element of risk that just isn't necessary when doing a complicated procedure like a bilateral DIEP. MAYBE THEREWILL BE A TOUCH UP PROCEDURE FOR WHICH THE ADDITIONAL PROCEDURE WOULD BE MOREappropriate

Dear Considerate8780,
I understand your concern. It is best however that you consult with a board certified plastic surgeon to determine whether you can have several aesthetic surgeries in one session, as this would depend on various factors including but not limited to your general health condition, the type of anesthesia that will be used, and the type of surgeries that will be performed among others.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for your question.  A double mastectomy with a DIEP reconstruction is a complicated procedure that takes place during a full day in the operating room.  The breast cancer surgeon has to operate to remove both breasts (possibly also with removal of lymph nodes).  The plastic surgeon (usually with at least one if not more additional surgeons) has to carefully find the blood supply to the tissue on each half of the abdomen, prepare the blood vessels in the chest and then transfer to the tissue in the abdomen to the chest under a microscope.  (That's why this is called microsurgery!)  Although it would be technically possible to do liposuction at the same time, it would be much better to wait to do it at a second stage revision procedure.  This would typically be done 3-6 months after the initial surgery and is a good time for doing touch-up things like liposuction and finishing touches like nipple reconstruction.