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While the initial reconstruction usually is planned at a stressful point in the patient's life, the second stage is quite different. If you're opting to do nipple reconstruction, this can usually be done during phase 2 as well. How Long is the Recovery Period from DIEP Flap surgery? What about bruising? Tissue from your back or — less commonly — your buttocks may also be used.
Such health conditions or treatments may delay or complicate the healing process. Don't beat around the bush or be embarrassed to ask anything that's on your mind. Symptoms also include discoloration at the reconstruction site, the breast becoming cold to the touch, fever, and the development of open wounds in the later stages of necrosis. Medial thigh-based flaps (TUG, VUG, DUG, PAP): These procedures use the skin and fat from the inner thigh, along with blood vessels that may be removed from the muscles. For a delayed DIEP surgery, your plastic surgeon inserts tissue expanders in your chest and then waits for the second stage of the DIEP flap surgery to completely rebuilding your breast. In: Hall-Findlay EJ, Evans GRD, eds. Breast reconstruction with flap surgery is a complex procedure performed by a plastic surgeon. You can read about that here. The plastic surgery team at Rowe Plastic Surgery uses their expertise to carry out successful breast surgery procedures. The breast is reconstructed entirely with your own tissue, so you don't have to deal with implants.
4%, in the nipple-areolar complex. Although some surgeons prefer immediate flap and nipple reconstruction during the initial procedure, most separate this into 2 or more procedures. A new technique for breast reconstruction, autologous fat grafting, uses liposuction to gather fat tissue from your thighs, abdomen or buttocks to reconstruct the breast or to improve the appearance of your breast after reconstruction. These adjustments are a normal part of the breast reconstruction process and are performed after you have fully recovered from your DIEP flap procedure. Looking to book a consultation? Have you visited the Nancy's Point FREE Resource Library yet? A retrospective study by Patel et al indicated that in patients who undergo flap-based salvage reconstruction in radiated breast tissue, latissimus dorsi flaps (plus implants) and abdominally based flaps (consisting of muscle-sparing TRAM or DIEP flaps) have similar postoperative complication rates. This may be performed to complete an implant-based reconstruction or enhance the look of the breast not affected by breast cancer (to retain symmetry and aesthetic appeal). 12] Future refinements can be avoided by paying attention to the details of flap orientation. Advise the patient to avoid tobacco products for 8 weeks prior to surgery. Flap procedures result in larger incisions that take longer to heal, so they require a longer recovery period and may require a longer hospital stay. Conversely, a small implant often can solve the problem.
I share about my experience with DIEP to help inform anyone interested and to reassure others who are thinking about this option. There does need to be adequate time post-phase 1 for healing. Some helpful notes about mastectomy DIEP flap recovery include: For most women, DIEP flap surgery recovery takes between six and eight weeks. You can live a normal life after your cancer, and regaining your figure is a way to help yourself physically and emotionally. This decision is ultimately the patient's, but fortunately legislation has made reimbursement possible for surgery on the opposite breast to match the reconstructed breast. Free flaps: A free flap moves tissue, fat, skin, and some or none of the muscle from one area of the body to make a new breast. Inspect the mastectomy flaps carefully. In addition, with the onset of menopause (ie, decrease in estrogen levels), the relative amount of fatty tissue increases as the glandular tissue diminishes. Practice Guidelines in Oncology: Breast Cancer. There were similar follow-ups periodically over a period of months. In: Harris JR, Lippman ME, Morrow M, Osborne CK, eds. DIEP flap surgery is not for everyone. Is DIEP phase 2 covered by insurance? Close cooperation with the oncologic surgeon can alleviate problems, since technically no breast tissue lies inferior to this plane.
A pedicled TRAM flap uses your whole rectus muscle — one of the four major muscles in your abdomen. When the procedure is done simultaneously with a mastectomy, it's called immediate breast reconstruction. Are there any new developments or ongoing research in breast reconstruction? Your plastic surgeon will describe your surgical options and may show you photos of women who have had different types of breast reconstruction. When Can DIEP Flap Reconstruction Be Performed? But this has been largely replaced by its free flap version, where the muscle can be totally or partially saved. As in the free TRAM flap surgery, a microscope is needed to connect the tiny blood vessels. The deep inferior epigastric artery and vein flap arguably is a refinement of the TRAM flap; likewise, using the internal mammary vessels for a free TRAM flap procedure arguably is a refinement of the traditional use of the thoracodorsal vessels. How Long Until I Can Exercise After Surgery? DIEP flap reconstruction involves taking skin and fat from the lower abdomen.
Patients can choose between a 2D tattoo that adds color only, or a 3D tattoo which also adds more detail (e. g. Montgomery glands) to make the final result even more realistic. In: DeVita VT, Lawrence TS, Lawrence TS, Rosenberg SA, eds. An abdominal wall flap procedure uses tissues from the tummy. The shape of the bra will help shape your breasts as they're healing. Schedule Your Consultation Today. Your DIEP flap procedure can be performed four to six months after radiation is complete. A literature review by Yun et al indicated that although there has been an increase in the use of implant-based breast reconstruction techniques in the setting of postmastectomy radiation therapy (PMRT), quality of life and sensory recovery are better in patients who undergo autologous reconstruction with PMRT. How Will My Breast(s) Feel After Surgery? However, you might run into issues with Medicare and/or Medicaid coverage which can vary state to state. Some surgeons prefer placing sutures through the skin at the inframammary fold (IMF), while others simply mark this area with a pen. To summarize, at the revision of a DIEP flap reconstruction, we're sucking out fat from areas where you don't want it, adding fat to areas where you need it, cutting out extra skin, and tightening up the skin on your breasts, your abdomen, your armpits, wherever there's all that loose skin.
Most of the time, the thighs only provide enough tissue to make a small or medium-sized breast. The feeling might return after a few months or years or not at all. The surgeon has more options for revising a breast reconstructed with an implant and a latissimus flap than one with an implant alone, and the additional procedure requiring replacement of the expander for a permanent implant is avoided. Boehmler JH and Butler CE. Diseases of the Breast. Our surgeons also discuss how acellular dermal matrix, a biologic mesh often used to hold or support the implants, may play a role in the reconstruction. Usually, dog ears will go away on their own. Recovery after revision of a DIEP flap breast reconstruction is much easier than recovery after the initial DIEP flap operation. During a free TRAM flap procedure, the surgeon disconnects a section of abdominal tissue — including skin, fat and sometimes muscle — from its blood supply and attaches the tissue to blood vessels in your chest area using microsurgical techniques. So, be clear about what you want and expect.
I would even suggest that any such sort of insistence is a red flag indicating you might need another opinion and/or surgeon. For the next few weeks, you can expect pain and soreness that will improve as you advance through recovery. Less than 5% of surgeons in the United States perform this intricate procedure, and the board-certified reconstructive surgeons at The Breast Center Park Meadows Cosmetic Surgery are proud to be among them. Expander-implant breast reconstruction. Acceptable donor site scar pattern.
Updated 2021 Feb 17]. Long answer, keep reading. 7% suffered local recurrence that included the skin/subcutaneous tissue, 0. Tissue flap procedures can also have some downsides that need to be considered: There are many different types of flap procedures. And yeah, I was super fortunate to experience no pain after phase 1. What to Expect After Surgery. If I think of any, I'll add them, so you might want to stop by again if DIEP phase 2 is in your future. If desired, the reconstructed nipple and areola are later tattooed to add color. Those who are concerned about living for some time without breasts may also prefer this option. Instead wear a bra that has a more cupping shape, such as a foam bra with or without an underwire that has, I guess, a more normal breast shape. 1245/s10434-019-07592-5.
One of the main differences is the LD flap transfers more muscle than the TAP flap. 2021;147(2):281-292. Before surgery, follow your doctor's instructions on preparing for the procedure. Andrades P, Fix RJ, Danilla S, Howell RE 3rd, et al. When using implants, the shape and feel of the reconstructed breast can be difficult to recreate. The pandemic definitely added another layer of stress, but I decided to proceed both times nonetheless. It uses your own tissue and sometimes can be completed the same day as your mastectomy.