DIEP flap & cosmetic expectations with prophylactic mastectomy for brca. Breast surgeon said most women have mediocre results

Breast surgeon said the pics I see online are ONLY the best results. He said plastic surgeons will never post their mediocre or poor results because no one will want them (makes sense). He said women who do best psychologically post diep are those that are happy to reduce risk of cancer or get rid of a cancer and NOT have to wear a prosthesis. I have BRCA and am approaching 60 yrs. old but still concerned about my appearance. Is my surg. correct? Maybe I should just do surveillance then.

Doctor Answers 7

#diep breast reconstruction

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Hi. The statement that most patients get mediocre results wiith DIEPs is nonsense. In good hands you can look as good or if not better with respect to shape and volume of the breasts compared to preop. Using your own tissue feels more natural, looks more natural and if all goes well will last a lifetime. Most women love the fact that they get a tummy tuck as well. Regards D

Realistic expectations for reconstruction

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Sadly, I do believe that many plastic surgeons do not want to post pictures of breast reconstruction mostly because so many general (oncological mastectetomy performing) surgeons do not leave them with much healthy tissue to work with, handicapping their results. The plastic surgeons I work with have over 50 breast reconstruction before and afters on the website and many more candidates because the work is so consistent and so exceptional. If your doctor doesn't want want to show their work, find out why. There are plenty of great surgeons who will show you examples that can give you an idea of what you might expect.

Heather Richardson, MD, FACS
Beverly Hills General Surgeon
5.0 out of 5 stars 2 reviews


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Given that you have the BRCA gene, I'm sure your breast surgeon has told you that you have a 80% lifetime risk for breast cancer.  If you are opting for a prophylactic mastectomy, then you can also opt for immediate reconstruction.  Without a formal physical exam, it is impossible to give you any recommendations. If you are a candidate for autologous reconstruction using your own tissue, the DIEP flap procedure can yield some outstanding results.  Please visit with a board certified PS to learn more about your options.

Best wishes,

Dr. Basu
Houston, TX

DIEP flap & cosmetic expectations with prophylactic mastectomy for brca.

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There are excellent alternatives to flap surgery for reconstruction following  prophylactic mastectomy

You may even be a candidate for direct to implant one stage reconstruction

Review all the options available

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Dr Kayser

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Thank you for your question. If you are contemplating prophylactic mastectomies, it is likely that you will have what is referred to as a nipple sparing mastectomy which preserves the entire skin envelope of the breast, including the nipple/areolae complex. The most significant advancements that have contributed to improved results in breast reconstruction surgery relate to the preservation of the nipple and areola and also the use of fat transfer techniques. Although implants have significantly improved in quality, ultimately, the ability to achieve such good cosmetic results in patients who have had nipple sparing reconstruction with fat grafting using implants has grown leaps and bounds. A DIEP flap or other muscle transfer type techniques are very intense surgically oriented approaches to reconstruction, and although they have certain advantages, namely that being the complete use of your own tissue, they leave scars and potential risks such as muscle weakness and hernia. I would encourage you to research into expander/implant reconstruction as noted above since these results can be outstanding. Finally,  the ability to completely reconstruct the breast using only your body fat , without any muscle or skin flaps whatsoever, is possible. This would require  the use of what is called BRAVA expansion and fat grafting, and could all be performed in stages in the outpatient setting.  The results of this approach to breast reconstruction, along with a nipple sparing mastectomy would allow you to achieve  a result that would be virtually cosmetic in appearance. I would seek out consultations with board certified plastic surgeons who are experienced in all approaches to breast reconstruction. I hope this helps and have a wonderful day. Dr Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
5.0 out of 5 stars 43 reviews

DIEP flap

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Breast reconstruction for BRCA + is a personal choice. You should discuss the risks with your breast surgeon. AS for reconstruction there are options using autologous tissue or non-autologous( implants) reconstruction.  Best of luck.

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

Cosmetic expectations with prophylactic mastectomy and DIEP reconstruction for BRCA

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Thank you for your question. I am sure your breast surgeon explained to you that your lifetime risk of developing breast cancer is significantly higher comparing to general population because of BRCA gene. Your cosmetic concern is reasonable and it is very important to have realistic expectations. Your reconstructive surgeon would
take time and effort to explain to you what to expect. 

Every surgery is not without risk, however if you have enough tissue on your tummy to be used for reconstruction of both breasts the results in hands of experienced microsurgeon can be very good.

I hope that helps.

Best wishes.

Elena Prousskaia 

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.