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How Long Does a DIEP Flap Procedure Take? What Is the Recovery Time?

March 22, 2013 by

This week Charleston breast surgeons Dr. James Craigie and Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answer your questions about DIEP flap surgery. 

 

Q: Approximately how long does the DIEP flap surgery take on one breast?

 

A: Thanks for your question.

A unilateral DIEP typically takes from 3-6 hours, depending on whether you already have had a mastectomy, and on how complicated the microvascular anatomy of your particular flap turns out to be.

Richard M. Kline, MD

Center for Natural Breast Reconstruction

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Q: I do not personally know anyone that has had DIEP flap surgery. What should I expect within the first two to three weeks of recovery after DIEP flap surgery?

A: The first 4 days will be in the hospital, the next three weeks you will be very mobile but no driving. After one month your drains will be out and you will feel much better. Over the next 6-8 weeks you should be getting back to normal. Let me know we will be glad to let you talk to one of our patients who is in a similar situation.

See you soon.

James E Craigie, MD

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

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Can I Have Reconstruction Surgery Even If My Radiation Treatments Damaged My Chest Area?

March 1, 2013 by

Are there natural methods of breast reconstruction surgery?
The following question is answered by Dr. Richard Kline of  The Center for Natural Breast Reconstruction.

In 2001, I had to have my implant removed because I had to a recurrence of breast cancer. After chemo, my 36 treatments of radiation did considerable damage to my chest area. I did have a latissimus flap and it was a total failure! I look like a road map to California. I had both of my implants removed in 2007 because of infection that went into my right implant.

Sometimes I think I might be okay without breasts, but not really. I wear prosthetics, but they are uncomfortable. Is there any way to get a successful reconstructive surgery with one of the natural ways of reconstruction?

 

Natural Breast Reconstruction almost certainly represents your best chance for a successful reconstruction, even with your past unfortunate experiences. If you have adequate donor tissue in your abdomen, buttocks, or thighs, there is an excellent chance that it can be used for your reconstruction. Your past surgeries and history of radiation may affect the final appearance of your breasts due to effects on your skin, but they usually have no impact on our ability to successfully transfer your donor tissue using microvascular techniques. Contact us and we can talk more about your specific situation.

 

Richard M. Kline, MD
Center for Natural Breast Reconstruction

 

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

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Best of Ask the Doctor

February 8, 2013 by

charleston breast surgeonsAt The Center for Natural Breast Reconstruction, our mission is to help women everywhere make smart, informed decisions about breast reconstruction and overall healthcare.

Over the years, our surgeons, Dr. James Craigie and Dr. Richard M. Kline, Jr., have answered a wealth of questions about breast reconstructive surgery—from the different kinds of procedures to post-op healing tips.

If you’re searching for a thorough introduction to breast reconstructive surgery, here’s a sample of the invaluable advice our surgeons gave the past year:

Your Questions about Natural Breast Reconstruction and Implants Answered

Scarring After Breast Reconstruction Surgery

Tackling the Challenges of Breast Reconstruction After Lumpectomy and Radiation

The Benefits of DIEP Flap Breast Reconstruction Over Other Reconstructive Options

Is This Normal? Your Post Op Breast Reconstruction Question Answered 

Tips for Improving Recovery and Healing Time

If you are seeking advice about breast cancer, breast reconstruction, or healthcare options, please send your questions our way! We will address all of your questions with detailed and valuable insight straight from our surgeons.

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Natural Breast Reconstruction: What Are My Options If I Have Scarring?

February 1, 2013 by

The below question is answered by Dr. Richard M. Kline of The Center for Natural Breast Reconstruction.

I lost my implants in 07 due to an infection from my lymphedema. I had both removed and didn’t have reconstruction since the prior surgery was a failure. I have scaring from radiation in 2001. I’d like to think about reconstruction again BUT afraid of failure due to the scaring. Do I have options? Really would rather not have implants, I’ve both types, didn’t like either but would accept silicon over saline.

Hello,

Natural Breast Reconstruction almost certainly represents your best chance for a successful reconstruction, even with your past unfortunate experiences. If you have adequate donor tissue in your abdomen, buttocks, or thighs, there is an excellent chance that it can be used for your reconstruction. Your past surgeries and history of radiation may affect the final appearance of your breasts due to effects on your skin, but they usually have no impact on our ability to successfully transfer your donor tissue using microvascular techniques. If you’d like more info, we could have our nurse Chris call you. If you wanted to send pictures, that would also be very helpful.

Thanks for your inquiry.

Richard Kline
Center for Natural Breast Reconstruction

Have a question about breast reconstruction question you’d like answered? Just ask us!

 

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DIEP Flap Reconstruction Surgery After Capsular Contracture

January 18, 2013 by

The below question is answered by Dr.James Craigie of The Center for Natural Breast Reconstruction.

Does anybody have any idea what the difference is “surgically” when DIEP surgery involves removing an implant that has developed a capsular contracture? That is what my situation is. I’m wondering if the skin that has been stretched over the implant will be removed, or become part of the new flap?

Thirty percent of our patients have previous implant surgery that has failed. During the reconstruction we remove the implant, implant capsule and any Alloderm that may have been used.   We also must return the chest muscle to its natural position because the implant always goes under the muscle. Unfortunately the muscle may be permanently changed from implant surgery. The stretched skin over the implant is allowed to recover and usually not removed.  If the skin initially needed to be stretched by the implant/expander then that indicates breast skin has been removed during the mastectomies. Usually skin from the DIEP will be needed depending on previous radiation and size of the DIEP breast. If the remaining breast skin is thin, tight, too scarred or damaged by radiation we may need to remove more of it at another surgical stage.

-James Craigie

Center for Natural Breast Reconstruction

Have questions for our surgeons? Submit your questions today and get answers straight from our surgical team! No matter where you are in your reconstruction process, we are here to help!

 

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Are You Comparing Apples to Apples When Weighing Your Breast Reconstruction Options?

January 11, 2013 by

We at The Center for Natural Breast Reconstruction know that the Internet is a great place to read and share information, but it is also a great place to become misinformed. Before making any decisions about your breast health, please make sure to contact a surgeon to discuss all your options and make the most informed decision you can. Keeping with the spirit of the Internet as a research tool, today’s Ask The Doctor Question comes from a discussion forum we participated in on WebMD.com. The answer highlighted below in pink comes from our team and showcases the importance of making sure you really are comparing apples to apples when weighing your breast reconstruction options.

Q: Has anyone had a hard time with breast reconstruction after bilateral mastectomy? I had two infections in my right expander, 2 and 3 months after my surgery. The first we conquered with antibiotics; the 2nd we did not, and I had to have it removed 4 months later. I spent the last 5 months healing from that, and just last week had the expander replaced. Hoping for the best this time! But there is significant skin loss on my right side, and my surgeon wonders if there will be enough stretch to accommodate saline fills to match my other side. And of course we all wonder if THIS expander will behave itself and not get infected. Has anyone had this experience, or one similar? Thanks.

A: Why don’t you go with the DIEP Flap procedure – they use the fat and skin from your abdomen area – I have had no problems from this procedure and I have heard of a couple of people who have had issues with infection with the expanders. Find yourself a Plastic Surgeon who does the DIEP Flap procedure

A: I also had a bilateral mastectomy but had to wait 2 years before reconstruction. I also had the expanders but had no problems, maybe it was too soon after your surgery. I would not recommend a tram flap ,it just sounds like an awful surgery.

A: There is a difference between and DIEP Flap and a trans flap.
The DIEP Flap they only take the fat and skin from your abdomen nothing else – they find a good blood supply at the reconstruction site. The Trans Flap is they take your stomach muscle and pull it up through to the breast cavity and also bring the fat and skin from the abdomen area. I for sure was glad that I did not do the Trans Flap.

A: (The Center For Natural Breast Reconstruction’s Answer) The free TRAM flap sacrifices a portion of the transrectus abdominus muscle (hence the acronym TRAM) but doesn’t tunnel it up through the abdomen. The DIEP flap does not use any of that muscle to transfer the blood supply to the reconstruction site. A skilled micro-surgeon with fellowship training in muscle sparing free flap reconstruction provides a permanent reconstruction option with a successful DIEP without sacrificing needed abdominal musculature. There is A LOT of great information on the web about this and what questions you should ask to make sure you are choosing a microsurgical team who has the experience and at least a 98% success rate. Talk to ladies who have had DIEP, GAP, HIP, SIEA flaps ( but not TRAM, it’s not the same) and see what kind of downtime they have had, you’ll probably find it similar to the amount you have had with the repeated implant/expander problems. Best wishes on your research and recovery.

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

 

 

 

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Natural Breast Reconstruction on Slender Females

December 21, 2012 by

implantsThe below question is answered by Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction.

I had a 4.6 cm lobular carcinoma treated with neoadjuvant chemo (ac+t). Five treatments to go scheduled to end on 1/17/12. Tumor had been reduced to 2.7cm thus far. Scheduled for bi-lat mast in early Feb. I am slim, 5’4″ and 112 lbs now. Normally about 120 lbs. surgeon here in nj is recommending expander and fills followed by radiation and several months later, an exchange. He says I may have enough abdominal fat for a tram flap for one breast. Could I come to you six months after radiation for a diep flap or some other procedure if I just have mast and do nothing else for six months following rads? Thank you

Hi,

Sorry to hear about your situation, but we would absolutely be happy to see you. If you have decided for sure you want to be reconstructed with your own tissue, I would strongly recommend that you stick to your guns and not have expanders placed, for the following reason. The expanders will create a “divet’ in your bony chest wall, which will not go away, and some of your flap volume will be required to fill the “divet,” and thus not be visible in the breast mound. If you were more “fuller-figured” this would not be an issue, but it is a huge issue for slender patients. We have encountered very few patients who cannot be reconstructed due to inadequate donor sites, although it’s not too uncommon for slim patients to not end up quite as large as they’d wished. If you’d like to send photos of front and back we could give you a preliminary assessment of your donor sites, although of course the absolute assessment is best done in person.

Good luck, and please feel free to call or email with any other questions.

Richard Kline
Center for Natural Breast Reconstruction

Would you like your breast reconstruction question answered? Just ask us!

 

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DIEP Flap Procedure: Is this covered by my insurance?

December 14, 2012 by

mental healthThe below question is answered by Charleston breast surgeon, Dr. Richard Kline of The Center for Natural Breast Reconstruction.

I had a double mastectomy last month and am considering the DIEP procedure. My insurance is Aetna PPO and I wanted to know if this is covered. Also, I keep reading about stage 11 follow up to do lipo on the upper abdomen so it is flat like the bottom half ( after surgery) . Is that part of the reconstruction and is it covered by insurance? Thanks

Hi,

I’m almost sure we are in-network for you, but our office will let you know for sure.

We use liposuction to help correct some donor site deformities, such as bulging of the upper abdomen, or fullness of the “muffintop” areas. Often, that fat can be used as graft to enlarge the DIEP flaps, or improve little areas of asymmetry. If we place fat in the breast, we add a code for fat grafting for the insurance company, but we never bill anyone for liposuction per se.

Hope this helps, and thanks for your question.

Richard Kline
Center for Natural Breast Reconstruction

Did you find this post helpful? We’d love to hear from you in our comments section.

 

 

 

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Breast Reconstruction Options To Correct Uneven Breasts

November 23, 2012 by

The below question is answered by the Charleston breast surgeon, Dr. James Craigie.

I had TRAM flap reconstruction in 2006 with revision and a follow up surgery in six months later. Since then some shrinkage has occurred in the reconstructive side and I have a hollow area on the upper portion. Do I have options for more normal looking breast without the hollow area?

You potentially have many options to improve your reconstruction. No one solution is perfect for all situations, but some options include repositioning the flap to a higher location, augmenting the hollow area with your own fat grafts (taken usually from abdomen, thigh, or buttocks), or using any excess skin / fat from under your armpit as an additional flap to lift and augment the TRAM (we call this a 5th intercostal artery perforator flap). Some more aggressive options would include placing a small breast implant under the TRAM flap, or adding a whole new microvascular flap from another area, although this is rarely in practice necessary.

Hope this helps. Please feel free to email or call with any additional questions.

Dr. James Craigie

The Center for Natural Breast Reconstruction

Would you like your breast reconstruction question answered? Just ask us!

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What Is the Recovery Period for a DIEP Procedure?

November 9, 2012 by

I’m getting ready to have reconstruction surgery in Mount Pleasant and the procedure I’m having consists of the tissue being taken from my abdominal area. How long is the recovery period for this procedure versus having the tissue taken from my back?

If the tissue from the abdomen is being transferred as a DIEP flap, you will probably require 4 – 8 weeks for recovery, of which less than one week will probably be spent in the hospital (usually 4 days in our practice). If the tissue is being transferred as a pedicled TRAM flap (in which your abdominal rectus muscle is sacrificed to carry blood for the flap), the time quoted by your surgeon for recovery may be about the same, but some patients may complain of discomfort for considerably longer periods. With either procedure, some patients will heal faster, and some will heal more slowly, not surprisingly.

When you say tissue is taken from your back, I assume you mean a latissimus muscle flap will be used. This is generally done in conjunction with a prosthetic implant being placed, as the latissimus muscle rarely has enough bulk to make a breast by itself. Generally speaking, a reconstruction using the latissimus is easier to recover from than one using the abdomen, because the latissimus is not used constantly for activities such maintaining posture and breathing. Additionally, at least two other muscles, the teres major and the pectoralis major, have functions which strongly overlap the function of the latissimus, and they are able to “take over for it” to some extent. There are no muscles which duplicate the function of the rectus abdominus quite as closely.

—Richard M. Kline Jr., M.D

Do you have breast reconstruction questions you want answered? Submit them here and get personal answers, straight from our doctors!!

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