DIEP breast reconstruction possible after umbilical hernia repair with mesh?

Question

Hello, I recently discovered I'm brca 2 positive at 55 years old with not ever having had cancer. I plan to do a bilateral mastectomy with DIEP reconstruction, but I'm not sure if I can be a candidate because of an umbilical hernia repair with mesh 9 years ago. Do you think I could still get the diep ? I thank you for your time.n

Christopher Pannucci, MD, MS · Answer

Hi lyddie,
A DIEP may still be possible after prior umbilical hernia repair. Obtaining a copy of the original operative note would be quite helpful. This would help to determine where in space for the mesh is located, and whether the perforating vessels through the rectus muscle might have been damaged. Your surgeon may choose to get a preoperative CT angiogram study, which could also help to determine whether there were adequate perforating vessels on which to base a DIEP flap.
Hope this helps.
Best,Christopher Pannucci MD MSBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Lewis Albert Andres, MD · Answer

With the advent of microsurgical perforator flaps, this form of reconstruction has revolutionized plastic surgery. Along with them, the application in breast reconstruction has been tremendous. By the replacement of the skin and soft tissue that is removed during the mastectomy with viable, well-vascularized, excess skin and soft tissue from the lower abdomen, a beautiful breast reconstruction may be achieved that is completely your own tissue. This Deep Inferior Epigastric Perforator (DIEP) flap has gained much notoriety for breast reconstruction today.The tissue is taken from the lower abdomen, much like that removed during a tummy tuck. Utilizing the excess tissue from this area and hiding the incision low on the abdomen, well-hidden within the panty line, the donor site is an excellent option for borrowing tissue for a breast reconstruction. This skin, fat, and soft tissue, along with its blood supply is taken and moved into the breast area. These small blood vessels are then reattached via assistance of a microscope to vessels in the breast area. This tissue is then shaped and molded to reconstruct an aesthetically pleasing breast reconstruction.With this new advent of perforator flap techniques, it is the most innovative and state-of-the-art technique used today in breast reconstruction, let alone plastic surgery as a whole. Unlike the traditional way of reconstructing a breast utilizing this tissue (aka TRAM flap), the DIEP spares the muscle of the abdominal wall, by carefully dissecting the blood vessel from within the abdominal musculature and leaving the muscle in place. This muscle-sparing, perforator flap type of reconstruction is beneficial for these reasons. There is less donor site morbidity from the abdomen, since the muscle is left intact. Along with that, there is less postoperative pain. The function of the muscle remains, so abdominal wall integrity remains intact and there is less chance of hernias or bulges, since the muscle remains. These problems are much increased with the conventional TRAM flap, but unlike it, the aforementioned benefits are obtained with the DIEP microsurgical free tissue transfer breast reconstruction.Unlike conventional TRAM flap reconstructions, use of our refined perforator flap techniques allow for collection of this tissue without sacrifice of underlying abdominal muscles. This tissue is then surgically transformed into a new breast mound. The abdomen is the most common donor site, since excess fat and skin are usually found in this area. In addition to reconstructing the breast the contour of the abdomen is often improved much like a tummy tuck. This well-vascularized flap reconstruction also is also completely your own tissue, and often resembles, moves, looks, and feels more like a natural breast than reconstructions using implants. Other perforator flaps used for breast reconstruction include the SIEA (Superficial Inferior Epigastric Artery), SGAP (Superficial Gluteal Artery Perforator), IGAP (Inferior Gluteal Artery Perforator), and TAP (Thoracodorsal Artery Perforator) flaps, among others.If you're interested in an advanced reconstructive procedure as such, very few surgeons have been trained to perform these and even fewer offer these procedures due to its complexity and skill involved. It may be difficult to find an experienced surgeon to perform this type of surgery with many patients, unfortunately, having to travel away to obtain such reconstruction.  It is possible - an exanimation and possible CT angiogram may be necessary to determine if even able tone attempted. Best wishes!

Allen Gabriel, MD, FACS · Answer

Thank you for your question.  Yes you are still a candidate for a DIEP. Please consult with an experienced surgeon that performs many of these procedures.  Best of luck.

Asaad H. Samra, MD, FACS · Answer

You very well could still be a candidate for the DIEP flap. It's inlikely that the umbilical hernia repair would have disrupted the blood vessels that feed the flap. Imaging studies, such as. CTA or MRA,  could be done to be certain. Best of luck.

Steven Wallach, MD · Answer

Yes, it is very likely that you are a candidate for a bilateral DIEP flap.  You can get a MR angio to determine if the perforators are patent.

DIEP breast reconstruction possible after umbilical hernia repair with mesh?

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DIEP breast reconstruction possible after umbilical hernia repair with mesh?

Answers (5)

Answer: DIEP flap after umbilical hernia repair

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