A DIEP flap on left side & prophylactic mastectomy w/ silicone implant on other side, will this look wrong? (photo)

There are really several things to take into consideration when answering this question.  Certainly, you could have a  bilateral DIEP, but keep in mind that you are having a prophylactic operation on the right side with immediate reconstruction (which will save more skin and potentially even the nipple if you preferred) and have already had a mastectomy with complete removal of skin and nipple on the left.  In addition, you have had radiation on the left side, which will impair the stretch of the skin and which is why a DIEP certainly makes sense for the left side.  So taking into consideration that your treatments are very different in terms of breast removal and postop therapy, it is unlikely that you will have a perfectly balanced result.  My personal preference is to keep the reconstructions the same on the two sides, but if your doctor is worried about the length of time the surgery will take, perhaps due to health reasons or other concerns, then two different types of reconstruction may not be unreasonable.  You should certainly be able to achieve something that looks symmetric in clothing.  Best of luck with your reconstruction! 

It's not wrong to do a DIEP flap and an implant reconstruction.  The right answer for you depends on your goals for size and symmetry and whether or not having an implant is acceptable to you.  For example, I think that based on your photos your breasts would probably be smaller than the right side with bilateral DIEP flaps.  The operative time is of minimal importance, as bilateral DIEP flaps can be done in about 6-8 hours.  Given where you are starting out, your left side will definitely look different than the right regardless of how how you chose to do the reconstruction.

Thank you for the question and for including pictures. A unilateral DIEP flap and contralateral implant will not look wrong, however, if you have enough tissue (hard to assess without an exam in person) for bilateral DIEP flaps then I would highly encourage you to find a surgeon who does a lot of these. In the right hands this surgery can be performed in 6-8 hours and in some cases even faster. In your area I would recommend seeing Dr. Hani Sbitany at UCSF. He is highly respected and has a practice where he routinely does bilateral autologous tissue reconstruction. Best of luck! 

I can make a few comments but without a physical examination I cannot be more accurate.  Of course you can have a bilateral or unilateral DIEP flap reconstruction.  If I begin with the breast surgeon performing the mastectomies my goal is to be done with all of the microsurgery, closure and have you in the recovery room by 3pm on a bilateral case and 1 to 2 pm on a unilateral case.  These cases don't take 12 hours.  If we start after the breast surgeon has performed bilateral mastectomies we are still done by 2 to 4 pm.  The time can vary if there is an issue with dissection of a flap or with the microsurgery but myself and my partner have done over a 1000 microsurgical cases each and perform DIEP flaps every week.Three basic forms of breast
reconstruction exist. You can use your own tissue, implants or a combination of
the previous two techniques. Your own tissue can be used in the form of the
DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one
stage or two stage. Two stage reconstructions are started by placing expanders
at the time of mastectomy. Once they expanders are placed they are able to be
inflated as determined by wound healing. The final type consists of combining
any of the above techniques.



If you are interested in being seen
in Austin, Georgetown or New Braunfels please give us a call. I know this is a
difficult time for you. The majority of my practice is devoted to
reconstruction for women with breast cancer or who are BRCA+

Hi Pleasant 1,Most plastic surgeons who do free flap breast reconstructions with DIEP flaps would prefer to do the same procedure for both breasts. Because your right breast will be an immediate reconstruction while the left side will be a delayed reconstruction, perfect symmetry will not be achieved. This will likely be seen in the size and orientation of the skin paddle. Nonetheless, the "feel" of the breast will be very similar because the tissue came from the same source. If you undergo breast reconstruction with an implant for one breast and free tissue transplantation for the other, the feel and look will be very different. Although it is very difficult to completely discerne from your photographs, it appears that you do have sufficient abdominal tissue for 2 breast reconstructions utilizing your lower abdomen. If your plastic surgeon does not feel comfortable doing a bilateral DIEP flap for you, you should respect his reservations and consider obtaining another opinion from someone who is also well versed in microsurgical breast reconstruction and does the operation on a weekly basis.