Breast cancer patients now have a lot of options when it comes to reconstructive surgery. The Deep Inferior Epigastric Perforator flap, also known as DIEP flap, replaces the soft tissue and skin removed during mastectomy with abdominal tissues[sup](1)[/sup]. This is an advanced method of breast reconstruction; unlike the TRAM flap procedure, the DIEP flap preserves all the muscles of the abdomen.
The
benefits of the DIEP flap vs. implant breast reconstruction are as follows:
1. The patient’s skin and fat are utilized to replace the breast volume that is removed during the mastectomy. This avoids the need to use an implant to recreate the breast volume.
2. Implant reconstruction patients may experience implant ruptures or capsular contracture, also known as breast hardening, that may need one or more maintenance surgeries years after their initial reconstruction. With DIEP flap reconstruction, the reconstructed breast tends to get softer and even more natural-feeling over time. After completing the DIEP flap reconstructive process, there is no anticipated maintenance necessary for the longevity of the reconstruction.
3. One advance in DIEP flap reconstruction is sensory nerve reconstruction of the flap. The hope with this additional step in a DIEP flap reconstruction is to provide sensation to the transplanted tissue. At this time, we are not doing this routinely in all cases, but rather it is offered in select patient scenarios. Your surgeon can discuss this option, review the pros and cons, and determine if sensory nerve reconstruction should be included as part of your reconstruction.
4. Post-operative pain is a common concern for patients considering DIEP flap reconstruction. It is often falsely assumed that implant reconstruction is less painful since it has a shorter operative time compared to the DIEP flap and does not involve surgery to the abdomen. At Breast Reconstruction Associates, we utilize a post-operative pain protocol that effectively manages most patient’s pain without requiring the use of narcotic pain medication.
In our practice’s experience, patient’s recovery and healing after DIEP flap reconstruction are actually significantly easier than what most people anticipate. Many of our patients choose to go home after a two-night stay in the hospital.
Truly, the DIEP flap is an excellent breast reconstruction option for women which results in a natural-looking and feeling breast after mastectomy, especially in women who prefer to avoid the use of implants. If you want more information about today’s “gold standard” in breast reconstruction, feel free to contact us at Breast Reconstruction Associates, your DIEP flap experts in Dallas Fort Worth, Texas.
There is an overwhelming amount of information on the internet about breast cancer related topics. When you are newly diagnosis with breast cancer, trying to digest this high volume of information can feel like trying to drink from a fire hydrant. The checklist below provides a good starting point for things to consider when deciding your treatment plan.
Research. It is common to want to rush the process along when you are given the shocking news of a breast cancer diagnosis. While this is very understandable, it is also very important for you to take enough time to understand all of your options. A discussion with your doctors will provide you with answers and reputable resources to reference.
Talk to your doctor. With the emerging popularity of social media, patients frequently get information from online support groups and other patient forums. Although having the support of others going through breast cancer is amazing and can be very helpful, it is also very important to remember that every patient’s situation is unique and you are only able to see part of the picture online. Questions specific to your care should be addressed directly with your doctor and their team for the most accurate information
Make the best decision for you. Breast reconstruction surgery is a personal decision, and several factors play into it. It can be helpful to bring your spouse, family, or support system with you to your consultation so they also understand your options and expectations. It is helpful to weigh the options with your support system, but ultimately you must make the best decision for YOU in your current situation.
Plan ahead. After any type of surgery there is an obligatory recovery period. The length of your recovery varies depending on the type of work you need to resume. Be sure to discuss the details of your expected recovery and post-op restrictions with your surgeon so you can plan accordingly with your support system and your employer.
Can I pick my breast size? The size of your breast reconstruction is dependent on your pre-operative body habitus. Part of your consultation with your reconstructive surgeon will involve discussing what your ideal breast size is (bigger, smaller, or in line with your current size). After examining you, your surgeon will be able to discuss your expected breast size and the likelihood of meeting your expectations. Your surgeon may show you photos of patients with a similar body habitus to help you get a better idea of what you will look like.
Know your timeline. Our goal at Breast Reconstruction Associates is to complete your reconstruction in as few surgeries as possible. Ask your surgeon how many surgeries they anticipate for you, and what the expected timing of each of surgery will be. Timing of reconstruction may have to be adjusted to prioritize the cancer treatment specific to your care.
What will I look like? Looking at photos of other patients who have had the surgery can go a long way in allaying your fears. At Breast Reconstruction Associates, we often look at photos together with patients to give them an accurate visual of the scars patterns they will have.
Ask questions. Nothing is off the table – make a list of all the questions you have and go over all of them with your doctor.
What about your nipples? Even with a mastectomy, some patients have the option of keeping their nipples; this is called a nipple sparing mastectomy. Depending on the location of your tumor, and the position (ptosis) of your nipples, your breast surgeon and plastic surgeon will assess and determine if you are a candidate for a nipple sparing mastectomy. If you are not able to keep your nipples, there are other great options to complete your reconstruction like nipple reconstruction or 3D nipple areola tattoos.
What is the goal of reconstruction? It is important to discuss realistic expectations with your plastic surgeon, and to understand the difference in reconstructive surgery and cosmetic surgery. The goal of reconstruction is to restore what cancer took away from you; to rebuild your breasts and be able to fit clothing evenly without the need to use a prosthesis. While it is a life-changing experience, it is often emotional during the transition. It takes time and perspective to accept and love your new reconstructed self. Don’t be embarrassed or afraid to discuss your emotions through your healing process.
In summary, take some time to learn about your options before moving forward. For more information, visit Breast Reconstruction Associates.
FAQs
Breast implants used in reconstruction are not lifetime devices. Most implants last between 10-20 years, though some may last longer. You may eventually need revision surgery due to implant rupture, capsular contracture (scar tissue hardening), or changes in appearance over time. It’s important to understand that breast reconstruction is often a journey requiring multiple procedures over your lifetime, and your surgeon should discuss a long-term maintenance plan with you during your consultation.
Implant-based reconstruction uses saline or silicone implants to rebuild the breast and typically requires fewer initial surgeries with shorter recovery times. Autologous or flap reconstruction uses your own tissue (usually from the abdomen, back, or buttocks) to create a new breast. While flap surgery involves longer operative time and recovery, it can feel and age more naturally, doesn’t require future replacements, and may provide the added benefit of body contouring. Each approach has distinct advantages and limitations that should be discussed with your surgical team to determine which is best for your body and lifestyle.
Breast reconstruction does not interfere with cancer surveillance, though reconstructed breast tissue can make mammography more complex. Your oncology team should be informed about your reconstruction method so they can adjust imaging protocols accordingly. Implant-based reconstruction may require specialized imaging techniques, while flap-based reconstruction typically allows for standard screening. Regular communication between your plastic surgeon and oncologist ensures that your reconstruction doesn’t compromise your ability to monitor for cancer recurrence.
While many insurance plans cover medically necessary breast reconstruction under the Women’s Health and Cancer Rights Act, out-of-pocket costs can vary significantly. These may include co-payments, deductibles, anesthesia fees, facility costs, and expenses for procedures not covered by insurance such as nipple tattooing or revisions for aesthetic refinement. Additionally, if you choose to reconstruct the opposite breast for symmetry, that procedure may be classified as cosmetic and require out-of-pocket payment. It’s essential to discuss the complete financial picture with your surgeon’s billing department before proceeding.
Most breast reconstruction results in some permanent loss of sensation in the breast and nipple area, though some sensation may gradually return over months to years. Breastfeeding after reconstruction depends on your specific surgery type and extent of nerve involvement. Flap reconstruction typically preserves a better chance of breastfeeding, while implant-based reconstruction may limit milk production if breast tissue was significantly removed. If future breastfeeding is important to you, discuss this explicitly with both your breast surgeon and plastic surgeon during planning.
The emotional aspects of breast reconstruction are just as important as the physical recovery. Many patients experience grief over their cancer diagnosis, body image changes, or if reconstruction doesn’t meet initial expectations. Consider connecting with a therapist who specializes in cancer survivorship or body image issues before surgery. Support groups specifically for reconstruction patients, rather than general cancer support, can provide insights from others at similar stages of their journey. Your surgeon’s office may be able to connect you with mental health resources or patient advocates.
Immediate reconstruction occurs at the time of mastectomy, while delayed reconstruction happens weeks, months, or even years later. Immediate reconstruction can be psychologically beneficial and requires fewer anesthesia exposures, but may limit surgical options if extensive radiation is needed. Delayed reconstruction allows time for complete cancer treatment planning, may offer more surgical choices, and gives you time to adjust emotionally before committing to surgery. Your breast cancer stage, need for radiation therapy, and personal preferences should all factor into this decision, which should be made collaboratively with your entire medical team.
Even if you think you are prepared for breast reconstruction surgery, more often than not, you will still have questions for your surgeon. This is very understandable since patients are normally taking a lot and are feeling stressed during that period.
For most patients, the diagnosis of breast cancer comes as a surprise with many associated uncertainties. Even patients who are considering delayed or prophylactic mastectomies and reconstruction have a lot of information to take in when making their reconstruction choices. At Breast Reconstruction Associates, we have been caring for patients like you since 2014. We want you to feel comfortable and informed about what autologous breast reconstruction can offer you. Here are a few of the most common patient questions we receive to help you further process and understand your decision to undergo breast reconstruction.
Q: How much pain can I expect after surgery?
A: Most patients experience a very tolerable degree of post-operative pain. Our pain medication regimen which is aligned with the Enhanced Recovery After Surgery (ERAS) protocol has proven remarkably effective. After surgery, most patients are able to do their regular activities of daily living and sleep with mild-moderate discomfort. The majority of our patients are no longer needing regular pain medications after 2 weeks.
Q: What will my breast size be?
A: During the initial reconstruction surgery, it is possible to control the width and the height of the flap when creating a breast. The depth, or projection, of the flap is largely dependent on the depth, or projection, of the abdominal tissue. Your surgeon should be able to estimate how close to your current breast size you will be after surgery at your consultation. It is possible to make adjustments to size and shape after the initial reconstruction surgery if needed.
Q: Will I have drains after surgery?
A: You can expect a drain in each breast that is operated on and 1-2 drains in your abdomen after surgery. Typically, patients will go home with all of their drains in place. While inpatient, your nurse will educate you regarding the emptying, recording of drainage and general care of your drains before you go home. Once at home, our team is available to address any questions or concerns that may come up. Most patients have their drains removed 1-2 weeks after surgery.
Q: What kind of bra should I wear after surgery?
A: You will be given a hospital-issued post-surgical bra after surgery. This eliminates the need to purchase a bra prior to reconstruction. After surgery, you may be fitted for a compression bra in our office for proper sizing and comfort.
Q: When can I start exercising again?
A: After surgery, we ask that you limit your activities to light walking, no core muscle use, and lifting weight less than 10 pounds. Once you are 4 weeks post-op, you may start cardio activities such as using the stationary bike or the elliptical machine. After this point, let your surgeon guide you as to how and when to get back into more strenuous activities. In general, most patients are free of restrictions and may use their core muscles again 12 weeks after surgery.
If you have additional questions, make a list! We are happy to be your resource for breast reconstruction information. Contact one of our offices in Fort Worth, Austin or Oklahoma City for more information or to schedule a consultation.
FAQs
Recovery timelines vary based on your job type and the extent of your surgery. Patients in desk-based positions typically feel comfortable returning within 3-4 weeks, though you may need modifications like limiting typing or phone use initially. If your work involves physical labor or standing for long periods, plan for 6-8 weeks of recovery. We recommend coordinating with your employer about a gradual return-to-work schedule if possible. Many patients find that taking 4-6 weeks off allows them to focus on healing without the added stress of work demands.
Yes, reconstruction involves surgical scars typically on the chest where the new breast is created and on the donor site (usually the abdomen). These scars are usually placed in inconspicuous locations and fade significantly over 12-18 months. Initially, scars appear red or pink and may feel firm, but they gradually lighten and flatten. Most patients find that scars become much less noticeable under clothing and swimwear. Scar management techniques like silicone products and massage can help with the healing process. During your consultation, your surgeon can show you exactly where incisions will be placed.
Sensation typically returns gradually over the first 6-12 months as nerves heal. Some patients regain near-normal sensation, while others experience permanently altered sensation—this varies significantly from person to person. Some areas may feel numb, while others become overly sensitive. These changes are usually manageable and often become less noticeable as you adapt. It’s important to discuss sensation expectations with your surgeon, as this is an individual aspect of recovery that’s difficult to predict.
Revision surgeries are common and can address concerns about size, shape, symmetry, or proportion. Most surgeons recommend waiting at least 3-6 months before pursuing revisions, as the breast continues to settle and refine during this time. Minor adjustments like liposuction or reshaping can often be done under local anesthesia in an office setting. More significant revisions may require a return to the operating room. Many patients find that what bothers them immediately post-op becomes less noticeable as swelling resolves and the breast matures.
Mammograms and imaging are still possible after reconstruction, though special techniques may be needed since the breast composition changes. Inform your radiologist about your reconstruction so they can adjust their imaging approach accordingly. Self-exams and clinical breast exams remain important for monitoring your health. Additionally, your reconstructed breast has a very low risk of developing cancer since it’s made from your own tissue rather than breast tissue. Regular follow-ups with your surgical team are important for long-term monitoring.
Yes, your reconstructed breast will age naturally along with the rest of your body. Factors like weight fluctuations, gravity, hormonal changes, and the natural aging process can affect the appearance of your reconstruction over time. Some patients may notice changes 5-10 years post-surgery that might warrant a revision if they’re concerned about symmetry. This is why maintaining a stable weight and following post-surgical guidelines is beneficial. Your surgeon can discuss long-term expectations and how lifestyle factors may influence your results.
Reconstruction is both a physical and emotional journey. Many patients benefit from connecting with support groups, whether in-person or online, to hear from others who’ve had similar experiences. Consider speaking with a therapist or counselor who specializes in cancer-related trauma or body image issues. Set realistic expectations by reviewing before-and-after photos during your consultation and asking detailed questions about potential outcomes. Allow yourself time to process your feelings about your cancer diagnosis and surgery. Remember that reconstruction is a gift you’re giving yourself, and it’s normal to have mixed emotions throughout the process.
Breast cancer is the most common malignancy affecting American women with one in eight women diagnosed during their lifetime (12.5% risk). There are several risk factors that can affect a woman’s risk, some of which are modifiable while others are out of our control.
Modifiable Risk Factors:
Body Mass Index (BMI) – Weight can significantly increase a woman’s risk for developing breast cancer as adipose aka fat tissue stores estrogen. Being overweight or obese increases estrogen exposure as well as cancer risk. It is important to maintain a healthy BMI to not only lower your breast cancer risk, but also decrease the risk of cancer recurrence if you are a breast cancer survivor. Your diet plays into this as well so it is important to eat a balanced, nutritious diet and avoid processed foods.
Alcohol consumption – This is an exponential risk factor in that the more alcohol you consume, the higher the risk of developing breast cancer. You should limit your intake to less than 3 to 4 drinks per week.
Tobacco use – As with most malignancies, nicotine use increases breast cancer risk. It also inhibits wound healing, so it is important to quit all nicotine products before undergoing surgical management.
Physical Activity – A sedentary lifestyle can increase your risk for breast cancer as well. Ideally, you should increase your exercise routine to 300 minutes per week, but risk reduction is observed at 150 minutes per week.
Hormone Replacement Therapy – Combination HRT (estrogen/ progesterone) increases breast cancer risk. Most women must stop these medications once diagnosed. It is especially important to perform routine self-breast exams and screening mammograms while taking HRT.
Non-modifiable Risk Factors:
Age – Breast cancer is an aging woman’s disease with a majority of cases diagnosed after the age of 50.
Gender – Women are overwhelmingly more affected by breast cancer than men, but men constitute 2% of all breast cancer diagnoses each year so it is important for men to practice breast awareness as well.
Genetics & Family History– Certain genetic mutations can increase a woman or man’s risk of developing breast cancer. Most people are aware of the BRCA1 and BRCA2 genes, but there are several other genes that increase this risk as well (CHEK2, PALB2, ATM to name a few). Even if genetic testing is negative for these mutations, patients are still considered to be at a higher risk than the general population if they have a family history of breast cancer.
Lifetime Estrogen Exposure – Starting menstruation before the age of 12, menopause at a later age, and delaying childbearing after the age of 30 or not having any children all lead to increased estrogen exposure and ultimately breast cancer risk.
Atypical breast cells – Not every breast biopsy is malignant; many are benign like fibroadenomas or cysts. There are some biopsies considered high risk lesions like atypical ductal and lobular hyperplasia and lobular carcinoma in situ.
While breast cancer rates have been increasing over the years, the good news is that more and more women are surviving this diagnosis. This is largely due to increased patient awareness and early detection as well as improved and increasing treatment options. If you have been diagnosed with breast cancer or a genetic mutation and are considering breast reconstruction surgery, reach out to us at our Fort Worth, Austin or Oklahoma City offices. At Breast Reconstruction Associates, we are committed to our patients’ overall health and reconstructive goals.
FAQs
While breast cancer can develop at any age, most cases occur in women over 50. Current guidelines recommend that women with average risk discuss screening options with their healthcare provider starting at age 40-45, though individualized screening plans depend on personal risk factors, family history, and medical preferences. Women with higher genetic risk or family history may need earlier screening and more frequent imaging.
Unfortunately, breast cancer cannot be completely prevented since some risk factors like age, genetics, and gender cannot be changed. However, significant risk reduction is possible through lifestyle modifications. Women who maintain a healthy weight, exercise regularly, limit alcohol, avoid smoking, and reduce hormone exposure can substantially lower their breast cancer risk compared to those with multiple risk factors.
Having a close relative (mother, sister, daughter) diagnosed with breast cancer increases your risk, even without carrying known genetic mutations. The risk elevation is greater if multiple family members were diagnosed, if diagnoses occurred before age 50, or if relatives had cancer in both breasts. Genetic counseling and testing may be recommended to determine if you carry mutations that significantly increase lifetime risk.
Combination hormone replacement therapy (containing both estrogen and progesterone) carries an increased breast cancer risk compared to estrogen-only therapy or non-hormonal alternatives. Women considering HRT should discuss their individual risk profile with their doctor, explore alternative symptom management options, and if HRT is chosen, plan for enhanced monitoring with regular clinical exams and imaging.
Yes, physical activity provides measurable protection against breast cancer development and recurrence. Research shows risk reduction benefits begin at 150 minutes of moderate weekly exercise, with additional protective effects at 300 minutes weekly. The benefits appear linked to improved weight management, reduced inflammation, and better hormonal balance.
Estrogen exposure over a woman’s lifetime significantly influences breast cancer risk. Longer reproductive years—from early menstruation to late menopause—increase cumulative estrogen exposure. Additionally, body fat produces estrogen, so excess weight elevates estrogen levels. Understanding this connection helps explain why maintaining healthy weight, having children, and managing reproductive timeline all influence risk.
Not all abnormal cells found on breast biopsy become cancer, but certain types—like atypical hyperplasia or lobular carcinoma in situ—carry higher risk of developing into malignant disease compared to benign conditions like cysts or fibroadenomas. These high-risk lesions often warrant closer surveillance, enhanced screening protocols, and sometimes preventive medication to monitor for future development.
