Can I have DIEP after a previous abdominal surgery?

Question

I am scheduled for DIEP flap reconstruction in December. I went to a BRA event last night and got some literature about reconstruction. One of the pamphlets says that you can't have DIEP after previous abdominal surgery. I have had 2 previous c-sections (vertical cuts) and an oophorectomy with a vertical cut 15 years ago. My PS is aware of this. Is this true or is this commonly done even though the literature said otherwise?

Christopher Pannucci, MD, MS · Answer

Hi smipigfarm,
DIEP is possible after many abdominal surgeries. The most common are prior laparoscopic surgery, prior Pfannensteil (low transverse) c section scar, and prior vertical midline below the umbilicus. In addition to the benefits of tissue based reconstruction, the DIEP surgery will generally remove or bury these scars
Rarely, an emergency c-section can injure the DIEP pedicle (your PS may order a CT scan to check. A prior below the belly button vertical midline scar is okay for two sided reconstruction (I would make this cut anyway, splitting the abdomen in half), but may mean you need two blood supplies hooked up for a one sided reconstruction that needs more than half an abdomen.
A history of an open gallbladder, with a right upper quadrant scar, can make the reliability of the skin below that scar questionable. I have definitely done DIEPs in patients with this scar, but a delay procedure may be needed, and minimal undermining should be performed for closure.
Meet with an experienced plastic surgeon, and they can explain your options.
Hope this helps.
Best,Christopher Pannucci MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Hisham Seify, MD, PhD, FACS · Answer

Yes, you can have a DIEP
after a previous abdominal surgery.This
really depends on the location of the scars and the assessment of the
surgeon.The vertical scar of the
midline will only prevent it from being raised together, instead of two
separate flaps.Again, this really
depends on the location of the scar.

Michael J. Halls, MD · Answer

Whether or not you can have a DIEP flap breast reconstruction after abdominal surgery depends upon the type of abdominal surgery and the direction and location of the scar(s). Vertical scars can pose a problem as to the amount of tissue available.

Hunter Moyer, MD · Answer

Hello smipigfarm,Thank you for highlighting an important point about breast reconstruction.  From your description it sounds like your previous surgeries will not prohibit DIEP flap reconstruction.  Vertical incisions in the midline are unlikely to disrupt the more laterally placed inferior epigastric vessels in your lower abdomen/groin.  The only real issue is if the previous surgeries separated your skin and fat from your abdominal wall.  If there is a concern, your surgeon can either order a CTA (CAT scan that examines the vessels) or start the surgery with a planned DIEP and convert to SIEA flaps if needed.  Good luck!

Mark A. Schusterman, MD, FACS · Answer

Thank you for your question.  The answer is: it depends on what type of incision.  The lower vertical incision should not be a problem for performing a DIEP flap.

Maria M. LoTempio, MD, FACS · Answer

It sounds as if your tummy is may not be usable but this does not mean other options cannot be used. To verify this a MRA will need to look at the blood supply of the abdomen. Your surgeon should have this information before your scheduled surgery date.  We also can take tissue from the back of your thighs or even your upper thigh/buttock area to reconstruct both breast if the abdomen is not useable.

Mark Gaon, MD - Account Suspended · Answer

If the surgery you had prior was an abdominoplasty or tummy tuck, then no, you could not have a DIEP performed. A low transverse C-section would not disrupt the blood supply needed for a DIEP, but your prior vertical incisions for your C-section and oophrectomy  may be troublesome. There is a test called a CT Angiogram that can be performed prior to your DIEP surgery that can assess the blood supply to your abdominal tissue. There is also a simpler method of assessing the blow flow with a Doppler device, but the CT Angio is far more reliable. It is best to bring this up with your surgeon as a concern. Without a physical exam, I really can't comment much further on the matter. Best of Luck with your upcoming reconstruction.

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