What would be my best option after a failed DIEP Flap? (photos)

Question

I had Prophylactic DMX w/ Diep Flap Recon. 8/15. On day 6 post-op I noticed the flap on rt. side was purple. PS watched it for 4 weeks, then cleaned out necrotic skin and about .25" deep of flap. 10 days later more died. I was put on a Wound Vac to close up the large hole. Now have scar tissue to be removed with less than 10% of my flap left & will have expander placed in 4/16. Is there a better alternative? Could I not try for a TUG or SGAP.

Steven Mapula, MD · Answer

A profunda artery perforator flap can be an excellent option in a case like this, and provide great tissue for autologous reconstruction

David Light, MD · Answer

I'm sorry to hear that you've had some trouble with your reconstruction. You are correct...another tissue flap would be an option to complete your right breast reconstruction. Options would include gluteal flaps (SGAP), thigh flaps (PAP or TUG flaps) or lower back flaps (LAP flap). Your current plastic surgeon may have already examined you and ruled out these options based on the amount of tissue available in these locations. If your plastic surgeon does not perform these procedures, a second opinion may be warranted to see if you are a candidate. I hope this helps.

Anh Lee, MD, FACS · Answer

I am sorry that you lost your right flap as this can happen for a variety of reasons but it looks like the vein clotted off.  At this point you have many choices to reconstruct that side from using an expander to implant, fat grafting, or another local or free tissue flap.  Have a lengthy discussion with your PS as to what may have caused the right side to fail as doing another free flap may have the same ending.  Good luck!

Steven Wallach, MD · Answer

I think more details about your history would be important to suggest other possible flaps. Yes, there are other flaps but a TE to implant  may be a good alternative if there are contraindications for a free flap.

Susan MacLennan, MD · Answer

HelloI am sorry to hear about your right DIEP flap experience. It looks like the left sided flap is healing fine, which is great. A tissue expander can be an option in cases like yours, as can a latissimus flap with implant for expander.. It may also be possible to do a different type of microsurgical flap such as a TUG, PAP, or GAP. These are less commonly done than DIEP. I would recommend that you discuss other options with your surgeon to see if s/he has experience these other flaps and whether or not they could be options for you.Best wishes-

Darryl J. Blinski, MD · Answer

Only in person discussions and examination would apply. My guess would be either LATS Flap or BRAVA with multiple surgery fat grafting...

What would be my best option after a failed DIEP Flap? (photos)

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What would be my best option after a failed DIEP Flap? (photos)

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