If you are a woman facing mastectomy you have a decision to make: do you want breast reconstruction? If the answer is "yes", plastic surgery holds the key. Although reconstruction cannot replace the breast(s) you were born with or allow you to breastfeed, it can restore your natural silhouette and make you feel "whole" again following mastectomy.
Depending on your health, breast reconstruction can be performed immediately after your mastectomy surgery so you can wake up with new breasts already in place. While the cosmetic results with immediate reconstruction are generally superior, breast reconstruction can also be performed at a later time once the cancer treatment has been completed ("delayed reconstruction").
The DIEP procedure is today's gold standard in mastectomy reconstruction. Advances in breast reconstruction have made it possible to use excess skin and fat from the abdomen (rather like the tissue removed during a tummy tuck) to construct a new breast without the need for implants or the sacrifice of abdominal muscle. This procedure, known as the Deep Inferior Epigastric Perforator (DIEP) flap, is a sophisticated modification of an existing procedure known as the TRAM (Transverse Rectus Abdominus Myocutaneous) flap.
TRAM flap surgery is a common breast reconstruction technique that requires the rectus abdominus (sit-up) muscle to be sacrificed and relocated to the upper abdomen. Unfortunately, this technique can be associated with significant post-operative pain, prolonged recovery, loss of abdominal muscle strength (up to 20%), abdominal bulging (or "pooching"), and even abdominal hernia.
DIEP flap surgery is similar to TRAM flap surgery but spares the rectus abdominus muscle. SKIN AND FAT ONLY are removed from the abdomen, transplanted to the chest and connected using microsurgery to create the new breast. NO MUSCLE is sacrificed. As the sit-up muscle is left behind in its natural place many of the above complications are avoided and the patient essentially receives a tummy tuck at the same time as the breast reconstruction. There also tends to be far less pain following the DIEP procedure, and a quicker recovery time.
Knowing the significant advantages of the DIEP flap it is easy to understand the reason for all the hype, especially for active individuals who don't want to sacrifice the strength of their abdomen. A breast that has been reconstructed with fat and skin will also look and feel more natural than an implant reconstruction and will last longer. Unlike an implant, the reconstructed breast also ages like a natural breast.
As with all types of breast reconstruction however, 2 or 3 procedures performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result. Unfortunately, due to the complexity of the DIEP procedure very few centers in the US perform the surgery so many patients will have to travel for the procedure. The good news is that many of these specialist centers will accommodate out-of-state and even international patients.
To learn if a breast center or plastic surgeon near you offers this advanced form of microsurgical breast reconstruction, please check the following websites:
www.diepbreastreconstruction.org
The lists on these websites seem fairly thorough but there are plastic surgeons out there who perform DIEP breast reconstruction that have not made the lists (for whatever reason). Having said that, currently there are only about 40 plastic surgeons in the US that routinely perform the DIEP flap procedure. Before choosing a plastic surgeon ensure that he/she is certified by the American Board of Plastic Surgery and has extensive experience with the procedure. Ask about the success rate of the procedure in their hands (most specialists boast a flap survival rate of at least 97%) and how many DIEP flaps they have performed.
Insurance companies are federally mandated to pay for the cost of breast reconstruction. Unfortunately, some patients will still face difficulties in gaining access to a DIEP flap surgeon and the procedure. Here again it pays to seek out plastic surgeons who specialize in the procedure as typically insurance specialists are available to help patients with insurance issues.
Minas T Chrysopoulo, MD.
Plastic, Reconstructive & Microsurgical Associates (PRMA),
9635 Huebner Road,
San Antonio, TX 78240.
Tel: (210) 692-1181,
Toll Free: (800) 692-5565.
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in DIEP flap reconstruction surgery after mastectomy for breast cancer. He and his partners perform over 300 microsurgical breast reconstructions with perforator flaps each year.
