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The Benefits of DIEP Flap Breast Reconstruction Over Other Reconstructive Options

diep reconstructionThe below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

What are the benefits of the DIEP flap breast reconstruction over other options?

I am going to break this question into two parts.

The first part is what are the benefits of the DIEP flap over reconstructive options using implants?  Let us start with the benefits of implants.  The primary benefit of implant is that the operations are shorter, they are potentially safer, and you do not need to operate on another part of the body. Additionally, implants are readily available, and if you do not have enough extra body tissue somewhere to make a breast, implants may be the preferred choice for this reason.  The advantage of the DIEP flap over implants is that it produces a much more natural feeling, warmer, and trouble free breast (after the reconstruction process is completed).  There is data to suggest that women tend to accept the reconstructed breast as their own more readily if it is made using their own tissue, in comparison to women who have a reconstructed breast using implants.  Additionally, many women feel that they have too much extra tissue in their abdominal area, and they may actually view removing this tissue to make a breast as an added bonus.

The second part of this answer is going to be why is the DIEP flap better than other reconstructive options using the patients own tissue, with the most commonly performed in our practice being the GAP or gluteal artery perforator flap, which is taking the buttock.  The primarily advantage of the DIEP over the GAP is that it is faster, and no position changes are needed during surgery to harvest the flap.  If the patient has adequate abdominal tissue to meet her reconstructive needs, we generally recommend using this as our first line option.  Having said that, however, the buttock serves very well to make breast, although the process is a little more tedious and lengthy.

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Your Questions about DIEP Flap Breast Reconstruction Answered

The below questions are answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

What are the most common reasons a diep flap will fail?

Specifics may vary from case to case and practice to practice, but all failures involve interruption of the blood supply. This can be caused from a clot forming at the arterial or venous anastomosis, or from a conformational change in the blood vessel which produces “kinking” and subsequent interruption of blood supply. Most surgical teams experience dramatically lower failure rates as their experience expands, and it can get very difficult to determine precise reasons for failure (and ways to prevent it) when failure is a very rare event, i.e., success rates of 98-99%, which is typical for experienced surgeons. The best teams will nonetheless strive, whenever they have a failure, to find some “take home message” which they can use to hopefully further minimize their failure rate.

If you had a failure with Diep on one side does that increase your chances of failing again if another flap procedure were done in the future?

In our experience, no, although in a large enough series it may. We have always been able to use the internal mammary vessels, supplied through collaterals, to successfully supply blood to a second flap after an initial flap failed. Generally speaking, the collateral supply to the internal mammary from one intercostal artery is probably sufficient to supply a new flap. I do think that it is advisable, however, to wait at least 3 months following an initial flap failure before attempting a second flap, as this gives time for tissue edema to resolve, and serum protein levels to return to normal.

My Diep Flap failed on one side. I wound up with a silicone implant on the right side, and it is not healing quickly. What should I be watching for ?

That depends on what you mean by “not healing quickly.” If you have an unhealed wound, then something is really wrong, and you should see your surgeon. If it simply hurts or “doesn’t feel right,” then it may improve with time, or you may be developing capsular contracture (a common problem with implants), which may not go away. If you still want a flap, you may well still be able to have one from your buttock or elsewhere.

Do you have a question for the Charleston breast surgeons at The Center for Natural Breast Reconstruction? We’d love to hear from you.


Can I Have My Current Implant Removed to Receive a Muscle-Sparing Free Flap Breast Reconstruction?

dr. richard kline

Dr. Richard M. Kline, Jr.

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

I had reconstruction with implants after my breast cancer diagnosis in 2009. How hard is it to go back and do breast reconstruction with a flap? What would the recovery time be?  Also, does insurance give you a hard time about taking out the implants and revising having a flap?

It’s no trouble at all to remove implants and replace them with a muscle sparing free flap breast reconstruction. We’ve done it successfully hundreds of times. Unfortunately, roughly 30% of women who come to us are seeking conversion from a failed or unsatisfactory implant based reconstruction. Recovery time after flaps is usually 6 – 8 weeks, although some ladies recover much faster. I don’t think insurance usually gives you a hard time—once you’ve started the reconstruction process, they seem to follow through until you are finally content with your reconstructed breast.

—Richard M. Kline Jr., M.D