Is Changing Type of Procedure During Operation a Usual Occurrence? Have Diep 1 Side and Tram on Other Side,

diep side is the radiated side,also side with gram negative pseudomnas, been on Cipro 3 wks, this is the breast that has shrunk and has abnormal tissue. Actually looks to me like partial flap failure, but the doctor not even considering. Says just wait.......

Doctor Answers 5

Partial DIEP flap loss on radiated side common.

It is well known that all types of flaps, free or otherwise, have more complications on the radiated side with an increase in partial flap loss.  I would need more information and some photos before I could give you definitive advice, but it may be that debridement is needed.

Houston Plastic Surgeon
4.9 out of 5 stars 77 reviews

Changing plans during surgery???

It is not uncommon to change plans from a diep to muscle sparing free tram depending on the quality and number of perforators found at the time of surgery.  The downside of free tram vs diep is obviously the morbidity placed on the abdominal wall.  However, you have to weigh this vs your chances of achieving a successful breast reconstruction.  I have done this long enough to always leave my ego at the door, in other words I will switch operative plans in order to maximize the chances for a successful reconstruction.

i am sorry that you are having problems with your breast reconstruction and I hope that your surgeon will get you back to normal as soon as possible

Stephen M. Chen, MD
Richmond Plastic Surgeon
4.8 out of 5 stars 34 reviews

Breast reconstruction choices

The surgical plan can sometimes change in the operating room based upon your anatomy. I always tell patients preoperatively about all kinds of flaps especially with these types of cases that depending upon the anatomy and how things progress flap decisions may have to be altered to provide the safest and best results possible.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast reconstruction issues

I'm sorry to hear that you are experiencing problems with your DIEP flap reoconstruction on your radiated side.   If you are experiencing an infection after autologous reconstruction and antibiotics did not successful treat your infeciton, and you are stating that your flap has "shrunk", I would be concerned about partial flap necrosis (where your reconstructed tissue is not getting enough blood supply.   In light of your active infection, you may need an intervention to debride (remove) parts of the flap not getting blood supply in the near future.   Options may included a latissimus flap either now or later.  However, a formal consultation would be needed to make any recommendations.  Please continue following up with your PS and your infectious disease (antibiotic doc).  Wishing you a speedy recovery.

Dr. Basu

Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 210 reviews

DIEP on one Side and a TRAM on the other

Obviously I am sorry that you are having an issue on the DIEP side after surgery and post op radiation if I am reading this post correctly.  The differences of DIEP and TRAM that are done using microsurgery are that the muscle is left in place in a DIEP.  Varying amounts of muscle are incorporated into free TRAMs and muscle sparing free TRAMs.  Pedicle TRAM flap rely on much of the muscle.  Usually only the leaving a small amount.  It sounds like you being treated and you should follow up closely till you can get resolution.

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 time consists of combining any of the above techniques.

If you are interested in being seen in Austin 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+

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.