Potential Issues to Watch for After DIEP Flap Breast Reconstruction

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

What potential issues should I be watching for right after having DIEP flap breast reconstruction?

I am going to split the answer for this into two parts.  First, what you should watch for while you are in the hospital (at which time you will, of course, have lots of help watching for things). Second, what should you watch for when you go home?

When you are in the hospital, we primarily look for changes in the vascular status of the flap.  There are monitors attached to the flap which will within seconds pick up any change in the blood flow to the flap.  If on further evaluation by the nurses, it shows that there is a problem, we will take you back to surgery immediately and attempt to correct the problem.  Fortunately, incidents such as these are rare, but if they do occur.  We have learned that the most important factor is to get to the operating room quickly, in which case we can almost always fix whatever might be wrong.

Thankfully, it is unbelievably rare to have a problem with the blood flow to the flap after going home, although it is not impossible.  Your primary concern should be to follow the specific directions which we have given in terms of positioning and brassiere support.  Most patients still have temperature monitoring strips attach to the flap, and this can serve as useful reassurance to let you know that your flap is fine.  Infections are extremely rare after DIEP flap surgery, but they can occur either at the reconstruction site or at the abdominal donor site.  Wound healing problems are not as rare as infections but may occur.  If you are not radiated, the most likely place to have a wound healing problem is your abdomen.  If you are radiated, it is very common to have a little bit of a wound healing problem where the healthy flap tissue meets the radiated breast skin.  Essentially all wound healing problems can be managed very effectively, so it is not something you need to worry about.

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Tackling the Challenges of Breast Reconstruction After Lumpectomy and Radiation

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

I had a lumpectomy in 2002 of the left breast followed with 33 rounds of radiation. I have since had a breast lift and reduction on the sound side in an effort to “even” my breasts. It worked for a while but the left continues to shrink. Any suggestions? Some suggest an implant, but I fear the cancer coming back and not being identified due to the implant.

Implants are indeed known to decrease the effectiveness of mammograms by about 1/3 after breast augmentation, and may well have the same effect when used in reconstruction after lumpectomy. Additionally, implants tend to be more poorly tolerated after radiation, although some people do quite well with them.

A flap of your own tissue could be used to augment your breast, but this would be a fairly large undertaking, usually (but not always) reserved for post-mastectomy reconstruction. Injections of your own fat, while proving to be a very useful adjunct to post-mastectomy reconstruction, are not routinely recommended (yet) for augmenting the lumpectomy defect.

One potentially very useful measure, if available to you, might be a full Marx protocol of hyperbaric oxygen treatment. A large part of the damaging effects of radiation is progressive obliteration of the microvascular circulation (smallest blood vessels). Hyperbaric oxygen (HBO) has been shown to very reliably stimulate the growth of new blood vessels in radiated tissue. Clinically, this often results in fairly dramatic softening of the radiated tissue, and a healthier appearance of the skin.

Thank you for your question.

-Dr. Richard M. Kline Jr., MD

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