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

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.

Hi, thank you for sharing your question. Based on the photos, your skin should make a significant recovery. You may be left with a noticeable scar but it will be hidden under the majority of your breast tissue. A DIEP flap is likely not your answer. If you have a significant volume difference between the breasts, fat grafting may be a good solution. I hope this helps.

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.

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

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..