Can You Perform a Buried DIEP Flap Procedure Utlizing Expanders?

The following question is answered by Charleston breast surgeon, Dr. James E. Craigie. of The Center for Natural Breast Reconstruction:

Q: I have had bilateral mastectomies without radiation. Cancer was in the left breast and I have been cancer-free for over a year.

I may be interested in DIEP reconstructive surgery. However, I am having trouble finding a surgeon to perform a buried flap utilizing expanders and my current mastectomy scars.

It is bad enough to have to have a large ugly scar across my abdomen, but to have my breast look like patches with two scars each is even more horrible than having cancer! It is even more disfiguring than the mastectomy and is not doing any woman a favor by making their self confidence and self image even worse. Are buried DIEP flaps one of the procedures that you perform?

A: Thank you for your question. I am sorry you are having difficulty finding a surgeon to address your situation. Every person’s situation is unique and if I had more info I could be more specific to you. However, I think I can help clarify why you are having a difficulties finding a surgeon to address your concerns:

During a mastectomy surgery, it is the breast surgeon removing the breast who has a major impact on subsequent reconstruction options. If no reconstruction was performed at the same time, then the surgeon was obligated to remove excess breast skin in order for the mastectomy incisions to heal without complications. It is important to understand the breast shape is determined by the breast skin that surrounds the new DIEP breast. If surgery removed the skin, then it has got to be replaced in some way.

In your question you spoke of tissue expansion. This technique does not create new skin but stretches the remaining skin. It also stretches the chest muscle and the muscle does not recover. Also, it’s important to note that some people will reject the tissue expander and have problems expanding the breast scar. In my opinion the technique of expanding the skin and later rebuilding the breast with a DIEP works best when the surgeons work together and extra skin is saved by the breast surgeon. Please try not to be discouraged! We have helped many women in your type of situation regain their self-confidence and their body image after mastectomy.

Also, please understand that in order to undergo the procedure you mentioned would require another surgery when the expanders are placed and the skin and muscle stretched over six months or sometimes less. When the stretching was completed then the DIEP procedure would be done but would require another two surgeries. It is unknown whether your body would stretch well and the process could be more complicated.

Most of our patients want to have reconstruction with their own tissue and do not want to sacrifice any important muscles. Our goal is to restore our patients’ self esteem and not simply scar their bodies and put them together with “patches.” Please let me know if you would like any more specific information we may need to touch base with you by phone.

James E. Craigie, M.D.

Center for Natural Breast Reconstruction

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Will I Have Any Breast Sensation After a DIEP Procedure? Will My Insurance Cover My Post-Op Stay?

This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q:  I was recently diagnosed with LCIS and then in a second and third look was re-diagnosed with ALH. I am leaning toward undergoing a  double mastectomy and reconstruction.

As a 45 year-old single mother of three, I would like to know a few things regarding your procedure.

1) Is there any nipple stimulation with the stomach flap DIEP procedure?

2) Is the week-long stay in Charleston covered by insurance in addition to inpatient charges?

3) How early can you get an appointment scheduled? My insurance rolls January 31, 2014 and my deductible has been met after my lumpectomy.

A: I am sorry you are having to make these difficult decisions. Regarding your questions:

1) Breast sensation after mastectomy is never normal. The more of your breast and nipple skin that is saved, the better the sensation after surgery. Also, the DIEP tissue has nerve tissue in it and if all goes well with the surgery, sensation can return faster. Again: it is not expected to be 100% normal. Implants have no nerve tissue and scarring can impair nerve healing.

2) There is at least one place that some patients qualify for that is free. Otherwise, lodging is not covered at all by insurance. We do have a list of places that give medical discounts.

3) If you would like an appointment, I will be glad to have my office contact you.

Thank you!

Dr. James Craigie

Center for Natural Breast Reconstruction

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

Ask the Doctor: Medicare, Scarless Reconstruction, and Options for Smaller Body Types

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q:  I was diagnosed with breast cancer in December 2010 and had a bilateral mastectomy/ stage 3 with 25 malignant lymph nodes removed. My treatment was chemotherapy followed by radiation. The last radiation treatment was September 2011. I have been researching about the DIEP procedure and am very interested in having this done. I am 66 years old. Do you accept Medicare out of state? The facility in San Antonio does not.

A: We will accept Medicare if you are otherwise (medically) a good candidate for the DIEP procedure. We can have our nurse Chris or P.A. Kim call you to get more information, if you like.

 

Q: Can you have scarless breast reconstruction surgery following a double mastectomy for triple negative breast cancer?

A: There’s really no such thing as “scarless” breast reconstruction, although it is often possible to conceal the scars quite effectively. We’d be happy to have our nurse Chris or PA Kim call you to discuss the details of your situation further, if you wish.

 

Q: What can you do for someone who is thin (5’4″, 116 pounds), has had a unilateral, nipple sparing mastectomy with radiation? Desired cup size would be AA or A only.

A: Most patients, even very thin ones, can still be reconstructed using only their own tissue, particularly if they only need one breast reconstructed, and don’t need it to be very large. If you have any excess abdominal skin / fat at all, it is frequently possible to use both sides of the abdomen to reconstruct one breast (stacked DIEP). Sometimes other donor sites are better ( buttocks or posterior thigh), and most patients have some extra fat spread over their bodies that can be added as free fat grafts at a subsequent procedure after the initial flap. It may be easier to tell which donor site(s) is best during an actual examination, but we can usually get a reasonable idea from photos.

Dr. Richard Kline

Center for Natural Breast Reconstruction

 

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

Flap Procedure Using Tissue or Muscle–What is My Best Option?

This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answer your questions.

Q:  had a double mastectomy in July 2012. I have one successful implant (right) and the left had to be removed due to infection. I need a flap procedure and want to know which one you usually recommend? I have had a lot of bad ratings for the stomach procedure. 

A: Thank you for the question, and I am sorry you have had problems with your implant.

When implants don’t work out,  usually using your own tissue can be an option to complete the process without using an implant. We specialize in using your own tissue but without sacrificing your muscle. Giving up the tummy muscle can be a problem and may have been part of the reason you have had less than favorable reviews on that subject. We prefer to use the body area that has sufficient tissue to rebuild the breast and take no muscle to do that. We can use the tummy, buttock or thigh tissue. I would be glad to give you more specific recommendations if I had more info. Let me know if you would like my office to contact you for more specifics.

Dr. James Craigie

Center for Natural Breast Reconstruction

 

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