You can still have a DIEP after you have had abdominal surgery (hysterectomy, c-section, appendectomy, bowel resection), but not after a previous tummy tuck.
Also thin women may have enough abdominal fat to spare. The amount of abdominal fat is usually underestimated by patients and doctors alike. Due to our experience in well over 600 cases , we are bold enough to say that nearly every women can have a DIEP flap. In the rare cases where this is not possible, we will do a SGAP flap.
A DIEP flap can be performed after previous chemotherapy or radiotherapy. Ideally your breast reconstruction is done immediately at the time of mastectomy. If this was not the case then we recommend you to wait 1 year.
Quiting smoking at least 1 month before surgery decreases complications.
Is additional surgery required ?
Asymmetry between both breasts, may require a contralateral (at the other side) breast lift or breast reduction.
Usually after six months a nipple and areola reconstruction can be performed under local anaesthesia.
Can I have a DIEP flap after I had another type of breast reconstruction o rafter failed breast implants with multiple revision procedures ?
Yes , If you experience complications from a previous breast reconstruction with an implant, you may consider removing it and replacing it by a DIEP flap.
What is a SGAP flap ?
Similar to a DIEP-flap, skin and fat tissue can also be taken from your buttocks, without removal of muscle.
What is a skin sparing mastectomy for genetic / hereditary breast cancer eg. BRCA1 or 2 ?
Young women who have to undergo a bilateral preventive breast amputation (mastectomy) , are good candidates for skin sparing mastectomies with DIEP flap breast reconstruction.
Only the breast tissue and the nipple plus areola are removed, while the skin is not removed. In some cases , the nipple and areola can be spared as well.
Skin sparing mastectomies give the minimal amount of scarring on the breast. The scar is located where the nipple and areola were. During the same operation, the breast tissue is replaced by fat and skin from two DIEP flaps. Skin sparing mastectomies are equally safe as classic mastectomies.
Sometimes preventive ovariectomies (removal of the ovaries) are indicated in hereditary breast cancer patients. We often combine this with the DIEP flap harvest, leaving no additional scars and avoiding additional surgeries for the patient.
Women who have had a previous mastectomy and are high risk for developing breast cancer in their breast, can have mastectomy of their breast and immediate bilaterals DIEP flap breast reconstruction.
How to choose your surgeon ?
Following breast cancer, reconstructive surgery can provide excellent results. Unfortunately, due to the complexity of the surgery few breast centers offer DIEP flap breast reconstruction despite the many advantages over older techniques. Only few plastic surgeons are specialized in DIEP flap surgery.
DIEP flap is microvascular surgery. This means that your surgical team uses a high-power microscope to perform the reconnecting of blood vessels. It requires extensive experience from the plastic surgeon, in addition to a well organised team and special facilities.
In our centre we have performed 600 free flaps in the last 5 years. This means at least 2 flap per week.
We have a success rate of 98 % .
It is best to arrive the day before , so that our radiologist can do the angio-scan in order to map out the best blood vessels of the abdominal flap. The receptor artery which we usually use is the internal mammary artery, which is located underneath the side of the chestbone. This is explored and dissected between two ribs, without the need of removing one of these ribs (which many surgeons do…).
You will stay 6 days in the hospital, and another week in a hotel (of your choice ; there is a BB for 35 £ per night), so that we can check the wounds on a regular base.
After 3 months the nipple will be reconstructed, as well as a contralateral breast reduction or uplift (at the other side) whenever this is indicated.
After another 6 weeks, the nipple tattoo can be performed , under a local anaesthetic. This can be done in London. In 10 % of cases this tattoo needs to be repeated.
Microvascular Plastic Surgeons : (working as one team) :
Dr Steven Colpaert , Dr Bert Oelbrandt
Both of us trained in Belgium and in the UK . Belgium is the country where per capita most DIEP flaps are performed in the world.
We have done 600 DIEP or other free flaps in the last 5 years , i.e. 2 per week.