Surgery was 10 weeks ago for bilateral mastectomy with immediate reconstruction. Left side via free tram and right side via diep. No problem with tram side. Diep side has significant bulge AND a hernia (confirmed). What is the best course to take now?
Answer: What is the best practice to treat abdominal bulge and hernia after DIEP flap? Hello! Thank you for your question! A true hernia after such procedures is very uncommon. Abdominal bulge is more common to occur, if they do at all. More commonly on the TRAM side. Regardless, you will need to discuss this with your surgeon. An examination will be necessary. A surgical procedure may be necessary, via simple repair/plication, component separation, or placement of a mesh, in order to correct. A determination on if these will even need to be repaired, and if so, how, will be made by your surgeon. Best wishes!
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Answer: What is the best practice to treat abdominal bulge and hernia after DIEP flap? Hello! Thank you for your question! A true hernia after such procedures is very uncommon. Abdominal bulge is more common to occur, if they do at all. More commonly on the TRAM side. Regardless, you will need to discuss this with your surgeon. An examination will be necessary. A surgical procedure may be necessary, via simple repair/plication, component separation, or placement of a mesh, in order to correct. A determination on if these will even need to be repaired, and if so, how, will be made by your surgeon. Best wishes!
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Answer: Hernia Repair with Mesh At this point, you will require a hernia repair with mesh. It is typically recommended to wait at least 3 months or 12 weeks to pursue any further surgery. Your plastic surgeon may or may not choose to have a general surgeon assist him or her with surgery if a true hernia is present. While mesh has its own set of risks, it is often necessary to reinforce weak or absent fascia following a hernia repair.
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Answer: Hernia Repair with Mesh At this point, you will require a hernia repair with mesh. It is typically recommended to wait at least 3 months or 12 weeks to pursue any further surgery. Your plastic surgeon may or may not choose to have a general surgeon assist him or her with surgery if a true hernia is present. While mesh has its own set of risks, it is often necessary to reinforce weak or absent fascia following a hernia repair.
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December 16, 2022
Answer: Bulge/hernia repair after DIEP Bulge/hernia reconstruction after DIEP is best managed with either an open Reeve-Stoppa type retro rectus sublay mesh or a laparoscopic mesh depending on the size and location of the bulge/hernia. I have found the Reeve-Stoppa repair to be extremely strong and durable. I use the existing DIEP abdominal scar as my incision.
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December 16, 2022
Answer: Bulge/hernia repair after DIEP Bulge/hernia reconstruction after DIEP is best managed with either an open Reeve-Stoppa type retro rectus sublay mesh or a laparoscopic mesh depending on the size and location of the bulge/hernia. I have found the Reeve-Stoppa repair to be extremely strong and durable. I use the existing DIEP abdominal scar as my incision.
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December 1, 2017
Answer: Needs further evaluation.. Bulges after DIEP flap harvest are a possibility (as well as free TRAM) - and this can be weakness in the abdominal wall, a true hernia, or possibly fluid.
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December 1, 2017
Answer: Needs further evaluation.. Bulges after DIEP flap harvest are a possibility (as well as free TRAM) - and this can be weakness in the abdominal wall, a true hernia, or possibly fluid.
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June 20, 2023
Answer: Abdominal wall reconstruction I'm sorry to hear that you are having trouble after your reconstruction. Bulges and hernias are more common with TRAM flaps, but can occur with DIEP flaps as well. You are probably aware that during a TRAM flap, the rectus muscle is taken along with the skin and fat for the reconstruction and weakens the abdominal wall. DIEP flaps preserve the rectus muscle, but if the nerve supply to the muscle is interrupted the muscle looses its tone and will result in a bulge. Simply reinforcing the abdomen with mesh will repair the hernia, but will not completely restore the muscle tone in the abdominal wall. The repair will require recruitment of your oblique muscles to restore abdominal tone and is successful in correcting the issue. I have treated many patients with both TRAM and DIEP flap bulges and would be happy to walk you through the procedure, explain the anatomy further and why it's successful. I hope this helps.
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June 20, 2023
Answer: Abdominal wall reconstruction I'm sorry to hear that you are having trouble after your reconstruction. Bulges and hernias are more common with TRAM flaps, but can occur with DIEP flaps as well. You are probably aware that during a TRAM flap, the rectus muscle is taken along with the skin and fat for the reconstruction and weakens the abdominal wall. DIEP flaps preserve the rectus muscle, but if the nerve supply to the muscle is interrupted the muscle looses its tone and will result in a bulge. Simply reinforcing the abdomen with mesh will repair the hernia, but will not completely restore the muscle tone in the abdominal wall. The repair will require recruitment of your oblique muscles to restore abdominal tone and is successful in correcting the issue. I have treated many patients with both TRAM and DIEP flap bulges and would be happy to walk you through the procedure, explain the anatomy further and why it's successful. I hope this helps.
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