Is a diep flap best for me ? (photos)

Question

I'm 36 and lost my right breast and nipple due to necrosis (the surgeon took me to an A cup rather than a D which I asked for ) I am having a third opinion tomorrow but so far both surgeons have suggested a diep flap is best for me , I'm frightened for any further surgery understandably and would be hopeful for another way ! My scarring is extensive and the scar sits too high for skin stretchers and implants to sit in the right place apparently :(

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

Thanks for your question. Unfortunately you have a lack of breast volume but also a shortage of skin, which will means that creating a natural appearing reconstruction with a breast implant will be very challenging. The gold standard reconstruction in this situation would be to transplant skin and fat from your abdomen, called a DIEP flap. The advantages of this technique are that it is warm, natural, your own tissue, will change with you (e.g. following weight fluctuation and ageing), and will last for the remainder of your life.

Ariel N. Rad, MD, PhD, FACS · Answer

Hello!Your right breast lacks not only volume but also skin. I don't recommend stretching your existing breast skin as that likely will fail. You absolutely need both extra skin and volume added to your right breast to give you symmetry and a natural breast shape and "hang" (called ptosis). This can be achieved one of two ways: either a latissimus flap (provides skin) + implant (provides volume), or with a DIEP flap which provides both skin and volume. Either technique can give you a great result. However, if you're a good candidate for a tummy tuck (i.e. you have extra hanging abdominal skin and fat) and you don't have long scars across your abdomen, then a DIEP flap can not only give you the most natural result but also the tummy tuck is usually a welcome cosmetic improvement to the abdomen. The other great advantage of the DIEP flap is the most natural feel, and natural aging process of your breasts. Furthermore you can avoid problems associated with implants such as capsular contracture, unnatural and asymmetric aging, rippling, firmness or other problems such as ALCL (a rare cancer of immune system).If you don't have enough abdominal tissue for a DIEP flap then the love handle (LSGAP) flap is a great second alternative. The DIEP flap, and especially the love handle flap, are very challenging surgeries that require great training, skill and experience to perform successfully. Seek a microsurgeon who has done at least 200 DIEP or LSGAP flap surgeries, rather than one who does either once in awhile.  All the best in your search!- Dr. Rad

Manish C. Champaneria, MD · Answer

Thank you for your question. A DIEP flap is an excellent option for you, and will provide healthy tissue to reconstruct your breasts. Although the DIEP flap can be a lengthy surgery and recovery, in the long run, you'll have natural breasts with good shape and projection. I do not believe fat grafting alone will provide the size and contour you desire. I recommend seeing a board certified plastic surgeon who specializes in microsurgery to perform your DIEP. Best of luck!

Patrick L. Basile, MD · Answer

Thank you for your question and for including pictures. A DIEP or muscle sparing TRAM is certainly a option for you. If all you want to do is balance out the right side with the left then it may be an option to perform fat grafting first and see if you are able to get aesthetically pleasing results with a simple outpatient procedure. You should discuss this option with your surgeons. I am a microsurgeon too and love free tissue transfer, but sometimes there is a better option and less invasive one. Best of luck!Dr. Basile

Is a diep flap best for me ? (photos)

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More Breast Reconstruction with DIEP Flap Questions

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More Breast Reconstruction with DIEP Flap Questions

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