Ask The Doctor – Do You Perform DIEP Free Flap Procedure Without Cutting Or Harvesting Muscle Tissue and Do You Accept BCBS Reimbursement?

White orchidsThis week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: Do you perform the DIEP free flap procedure without cutting or harvesting any muscle tissue? How many of these are performed by the physicians per year? Do you accept the BCBS reimbursement rates for this procedure?

Answer:

Thanks for your inquiry.

My partner and I are both trained directly by Dr. Robert Allen, the inventor of the DIEP (and sGAP, iGAP, PAP, etc.). He still drops by and operates with us occasionally. We will NEVER take any muscle tissue. However, with rare exceptions (dictated only by individual anatomy), it is impossible to harvest a DIEP without temporarily dividing part of the rectus abdominus muscle (although this almost never results in any functional impairment). If you have read or heard otherwise, that source is simply incorrect. I would be happy to discuss this with anyone who feels otherwise.

We currently perform (150 – 170) perforator flaps for breast reconstruction each year. We have performed a total of about 1700 flaps, of which about 1400 are DIEPs, about 300 are GAPs, and a few are PAPs, tDAPs, etc. Our DIEP survival rate when last calculated was 99.08%, our sGAP survival rate 95.7%. I would not be surprised if these were the best flap survival statistics in the world, but of course I can’t be sure, because we don’t know the details of other groups’ statistics.

We accept insurance as full payment from all carriers doing business in SC, and we are usually “in network by proxy” (or something like that) with all other carriers in the US.

We happily accept patients who have been operated on unsuccessfully by other physicians, no matter how many times, and no matter how bad the situation may seem.

I would be happy to discuss the particulars of your situation with you by phone or in person at any time.

Thanks again for your question, and have a great weekend!

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