Investigating Options following Necrosis - is diep flap the best option? (photos)

Question

I had necrosis following a breast reduction and lift which left me with extensive scarring on the lower pole of one breast and the breast is smaller than the non-scarred breast. I have since undergone another procedure to excise, close and remove the damaged skin, and because of the damage, my dr had to do a full thickness skin graft. Unfortunately, the majority of the graft failed. Is a Diep-flap my best option at this point?

Derek Fletcher, MD · Answer

I am sorry you had a significant complication after your breast reduction and revision procedure. I strongly recommend allowing your breast scars to mature for a full year (from the time that they were completely healed after the last operation) prior to planning a balancing procedure. Future surgery must address residual skin and tissue shortages. As the scars mature and the skin stretches, the shape of your breast will improve significantly. Sometimes the scars and skin recover enough to avoid skin replacing procedures like a DIEP flap or latissimus flap. If, at the one year time point, you no longer need a skin replacing procedure, you are a candidate for much less complicated operations like fat grafting or placement of a small implant to restore volume and improve symmetry.

Gary M. Horndeski, MD · Answer

Diep flap is useful to provide volume as well as surface area of skin and in your case reconstruction.  Your volume loss may be minor and can be corrected by fat transfer.

Best Wishes,

Gary Horndeski, M.D.

Christopher Pannucci, MD, MS · Answer

Hi TJ73,
DIEP flap is a belly-based free tissue transfer that is typically used to reconstruct the entire breast mound. It brings up excess skin and fat from the abdomen, with a blood supply, for whole breast reconstruction.
Picture #4 looks like the full thickness skin graft had 100% take, converting the open wound of picture #3 to a closed surgical wound (albeit with a color difference and contour difference). 
I would definitely suggest seeing your plastic surgeon regularly. The skin of the reduced breast tends to stretch out over time, and it may be possible to eventually remove the skin graft (potentially in a series of operations) and close skin-to-skin. A DIEP flap would not be your best option to replace skin only.
Hope this helps.
Best,Christopher Pannucci MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Samuel Lin, MD, FACS · Answer

Thank you for sharing your experience. I would continue to followup with your surgeon regarding next steps related to the area. DIEP flap breast reconstruction usually is in the setting following mastectomy for breast cancer treatment.... all the best..

Daniel Barrett, MD · Answer

Dear TJ73,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Investigating Options following Necrosis - is diep flap the best option? (photos)

Answers (9)

Answer: Breast reconstruction

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Investigating Options following Necrosis - is diep flap the best option? (photos)

Answers (9)

Answer: Breast reconstruction

Answer: Breast reconstruction

Answer: Skin necrosis

Answer: Skin necrosis

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Recommended reading

Everything you need to know about Breast Reconstruction

Our mission is to create a world where every investment in modern beauty is Worth It.