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

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.

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.

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