DIEP flap revision is a second surgery performed to achieve the final breast contour. When you undergo a mastectomy to remove breast cancer, you may receive either a nipple-sparing mastectomy or a non-nipple-sparing mastectomy. You may be tired and sore for a few weeks after your surgery. Sadeghi does his best to ensure these incisions (and inevitable scars) are easy to conceal under bras and bathing suits. When placed behind a latissimus flap, the implant can be round or anatomic depending upon the desired shape of the breast. Available from: Spiegel AJ, Menn ZK, Eldor L, Kaufman Y, Dellon AL. Your options for breast reconstruction timing include: - Immediate breast reconstruction: During immediate breast reconstruction, your DIEP flap procedure is performed by our reconstructive surgeons right after your general surgeon performs your mastectomy.
History of the Procedure. Second Stage DIEP Flap Surgery. During the procedure, the surgical team removes the tissue from the selected donor site and uses it to recreate the breast. Acceptable donor site scar pattern. The first stage is to place an implant expander and the second stage is to complete the tissue 'll likely need another operation to perform nipple reconstruction. What is the approximate size of the implant to be used? Tissue from your back or — less commonly — your buttocks may also be used. You may have drainage tubes in place for a short time after your surgery to remove excess fluids that collect in the surgical site. Boehmler JH and Butler CE. Both direct excision of excess fat and liposuction can achieve the desired result. It may or may not be important to note that I'm a person who has always bruised easily for whatever reasons. This usually doesn't happen until you've completed all your cancer treatments.
This should help eliminate the problematic lateral drift often observed in free flaps anastomosed to the thoracodorsal vessels. 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. In: StatPearls [Internet]. Suture the latissimus-serratus unit back to the chest wall in an attempt to restore the natural slope of the lateral breast. How Will I Feel After DIEP Flap Reconstruction? Most second stage breast procedures are performed on an outpatient basis; however, the procedure length will vary on the techniques being performed.
Saturday-Sunday: Closed. A pedicled TRAM flap uses your whole rectus muscle — one of the four major muscles in your abdomen. All we're doing is shifting fat and tightening skin. In addition, with the onset of menopause (ie, decrease in estrogen levels), the relative amount of fatty tissue increases as the glandular tissue diminishes. The decision to undergo breast reconstruction after a mastectomy is a personal one. Because DIEP flap breast reconstruction uses patients' own tissue to recreate their breasts, there is no need for routine maintenance screenings or surgery. An advantage to autologous reconstruction with regard to PMRT was also seen in a study by Reinders et al. Another popular tissue-based reconstruction is the TRAM flap reconstruction. To schedule your private consultation, call 212-628-7300. Our surgeons will close the remaining abdominal skin and create your new breast with the removed tissue.
Ideally, your breast surgeon and the plastic surgeon should work together to develop the best surgical treatment and breast reconstruction strategy in your situation. Tissue flaps are often used by themselves to reconstruct the breast, but some tissue flap procedures can be used with a breast implant if more volume is needed. Honest to God, if I didn't want to help other women contemplating DIEP and physicians learning and honing their skills for this stuff, I would refuse the photo sessions. Phase 2 discomfort was completely handled with Tylenol. DIEP flap surgery typically takes about 6-8 hours. Conversely, division of the nerve and of the tendon of the rectus muscle superior to the takeoff of the superior epigastric vessels gives the flap more freedom to rotate and helps eliminate the unsightly bulge in the xiphoid region. If one breast is larger than the other, this can be addressed with either fat grafting from another area of the body to add volume to the smaller one. However, you might not be able to have nipple sparing surgery.
If the IMF is lower on the reconstructed side, the flap needs to be elevated and suspended along its inferior portion while the new IMF is sutured to the chest wall. This provides a less invasive option, but not all women's SIEA blood vessels are adequate for this type of flap surgery. Initial reconstruction with autogenous tissue. The gluteal free flap or gluteal artery perforator (GAP) flap uses tissue from the buttocks (bottom) to create the breast shape. The plastic surgeon also provides information on anesthesia, where the operation will be performed and what kind of follow-up procedures may be necessary. SECOND STAGE BREAST RECONSTRUCTION | LIPOFILLING. You might see this type of flap called a superior gluteal artery perforator (SGAP) flap if the artery in the upper buttocks is used. Please let us know how we can help you and a member of our team will reach out to you shortly to assist. This time, I am mulling over doing 3D tattooing only. In more severe cases, dissecting the flap off the chest wall and moving it medially may be necessary. Help your breasts look natural under clothing or a bathing suit. What Is Second Stage Surgery? Nahabedian M. Options for autologous flap-based breast reconstruction.
The DIEP flap procedure has become the standard of care for autologous breast reconstruction using abdominal tissue, compared to the outdated TRAM flap procedure, which involves completely removing a muscle from the abdomen and inserting mesh. Our plastic surgeons set the standards for plastic surgery through their innovative procedures and meticulous attention to detail. Literally the best decision I ever made aside from being a mom. Because of the anatomy of this blood supply, many women who undergo reconstruction with a SIEA flap experience less post-operative pain than with a DIEP flap, without any risk of muscle weakness. As in the free TRAM flap surgery, a microscope is needed to connect the tiny blood vessels. See the images below. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Not all women have this blood supply; in many other cases, the blood supply is not sufficient. So, if you're going this route, be sure to get all this clarified as far as what to expect. Dr. Robert Garza has a dedicated focus on DIEP flap surgery (tissue based breast reconstruction). Because adequate blood supply is critical to the survival of transplanted tissue in flap surgery, your surgeon may prefer not to perform a pedicled flap procedure if you're a smoker or if you have diabetes, vascular disease or a connective tissue disorder.
Although refinements can improve small imperfections in a reconstructed breast, these should not be relied upon to correct improper planning of the initial procedure. Breast reconstruction is rarely considered a 1-stage procedure. Questions & Answers. Sensory Recovery of the Breast following Innervated and Noninnervated Lateral Thigh Perforator Flap Breast Reconstruction. Restore the inframammary crease. Even my medical team was a bit shocked by the amount of bruising I had. 2016; 23(10):3247-3258.
Available from: Last Revised: October 20, 2021. What's involved in phase 2? All the options require the use of microsurgery and reconnection of the blood vessels in the chest.
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