After DIEP Flap concerns, was told 10 months later, that the fascia was only tightened half way up? Is this the norm?

Question

Belly button down, flatter and little protrusion. Belly button up, VERY full and sticks out compared to lower tummy. I feel barrel shaped! I have voiced my concern with P.S, and was as finally told the fascia was only tightened half way up! Why wasn't this info offered before the surgery? It explains ALOT! It feels like I'm wearing tight spanx,half way up,and everything is shoved to the top! This does affect me pysically, and looks bad! Fixable, is it a revision? Is only 1/2 up normal with diep?

Ryan Rebowe, MD · Answer

Only repairing the fascia 1/2 of the way up the abdomen is a normal part of the DIEP flap procedure. This lowers your risk of venous thromboembolism and in many people will result in no noticeable difference in appearance between the upper and lower portion of the abdomen. The muscle can be tightened during a revision procedure at a later time with acceptable risk of VTE. I would make sure to discuss this with your surgeon if you are looking to have any secondary revisional procedures related to your DIEP flap reconstruction.

Derek Fletcher, MD · Answer

It depends on the surgeon. For the past 20 years, our group always performs rectus plication above the belly button during DIEP flap breast reconstruction in an effort to avoid the upper abdominal bulge you have experienced. Prior to this transition in our practice, upper abdominal bulging was far more common for our patients. Common risk factors for upper abdominal bulging after DIEP surgery include: patients with a body type that stores fat around their intraabdominal organs (visceral fat) with a round abdominal shape, history of multiple pregnancies, and a history of significant weight loss.

Lisa F. Schneider, MD · Answer

Thank you for your question!  This is a very understandable problem and one that typically requires surgery to fix.  It is up to the surgeon's judgement at the time of the operation to decide whether or not to plicate (or surgically tighten) the upper abdomen.  There may have also been additional factors during the initial surgery (the length of time of the initial DIEP flap procedure, any concerns or difficulties during the surgery, wanting to reduce potential risk of blood clots which can increase with a tight plication) that would have influenced his or her decision.  Regardless, this is a fixable problem that should be able to be repaired during an outpatient surgery.  This should also be covered by insurance since it falls under the umbrella of the initial cancer reconstruction procedure.  Take care and hope you are able to have this problem fixed! Dr. Schneider

Ali Sadeghi, MD, FACS · Answer

Thanks for your question.  With a DIEP flap an insignificant amount of fascia MAYBE removed and the closure of the fascial (Anterior Rectus Sheath) will cause minimal tightening of the lower abdomen. Usually during a second surgery to correct of scar position of the DIEP donor site, any bulges in the abdomen are addressed and a full plication will be performed in possible to restore the abdominal wall integrity and core strength.Hope this helps.

Ben Brown, MD (license emergency restriction) · Answer

Hello Wingracie,
Thank you for sharing your experience. During a DIEP flap, the fascia is tightened below the bellybutton. Even a DIEP flap, which involves the removal of very little fascia, involves tightening of the fascia to some extent - any closure of the fascial "defect" by definition tightens the lower abdomen. This is a necessary step to close the fascia and to centralize the bellybutton if more fascia is removed from one side than the other. 
It is uncommon, though certainly not unheard of, to perform a supraumbilical plication during a DIEP flap. Supraumbilical refers to the upper half of the abdomen, above the bellybutton. Any plication increases pain and is by no means 100% risk-free. Plication can cause bleeding and fascial tears as well as other issues. This is why many reconstructive surgeons choose not to perform supraumbilical plication as an extra step during closure of the abdomen - a supraumbilical plication is not essential to safely complete the operation.

After DIEP Flap concerns, was told 10 months later, that the fascia was only tightened half way up? Is this the norm?

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After DIEP Flap concerns, was told 10 months later, that the fascia was only tightened half way up? Is this the norm?

Answers (5)

Answer: Fascial Plication after DIEP flap

Answer: Fascial Plication after DIEP flap

Answer: Fascial Plication during DIEP

Answer: Fascial Plication during DIEP

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