Poor cosmetic result of DIEP flap scar revision. How can it be corrected?

Question

After stage 2 of the DIEP flap, 8 months ago, I'm left with a one sided lump on my lower left abdomen below the incision. The PS states its muscle and can not be treated with lipo. He didn't really explain how the muscle healed this way but did say surgery would be extensive and would have to be coded as a "hernia" in order for insurance to cover it. I can not imagine not having this fixed but do not want another extensive surgery. Anyone have any experience with this or thoughts on how to correct?

Nelson Castillo, MD · Answer

Thank you for your question. Unfortunately without a full series of photos, or perhaps even CT scan images to determine what may be taking place, it is difficult to offer treatment recommendations.  I would continue to voice your concerns with your surgeon so that they fully inform you of what is taking place and you can adequately research your treatment options.  If you are not finding the answers you want, certainly seek out second opinions from ASPS board certified plastic surgeons.

Robert Whitfield, MD · Answer

I do a perform DIEP flap cases several times each month.  The closer of the abdomen is very  routine in our practice.    The incision in the fascia is closed a particular way and has a few situations that can develop.  One is a bulge in the abdomen.  I have had this happen in a small percentage of patients and had to repair it with mesh.  This maybe what your Plastic Surgeon is referring too in this instance.

Joseph Poggi, MD · Answer

:) You really will need to post some pictures but I am disheartened that your surgeon is not able to give you a satisfactory explanation. It may be difficult but I would try and get an in person consultation with another plastic surgeon for a second opinion.  Nobody likes to fix another persons results, but they may help explain some things in a different manner so that you can decide if you want your primary surgeon to proceed with revision surgery or not.  Plastic surgery is more artful then any other discipline and you may be picking up on your primary surgeons discomfort with being able to give you the results you want or merely the fact that breast reconstruction is in effect "robbing peter to pay paul" and in this case, peter noticed.  Breast reconstruction is one of the most rewarding plastic surgeries to perform and I hope that you get resolution to your problems.

Poor cosmetic result of DIEP flap scar revision. How can it be corrected?

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