DIEP Flap Reconstruction Archives - Breast Reconstruction Associates

Common Plastic Surgery Risks | Breast Reconstruction Associates

Secondary Flaps: PAP and SGAP

Written by info@wildmonkeybrand.com on May 14, 2024. Posted in DIEP Flap Reconstruction.

Some patients may not be a candidate for the DIEP flap reconstruction. These patients may have a history of previous abdominal surgery that may have affected the DIEP vasculature. Examples of such procedures could be a prior abdominoplasty (aka tummy tuck) or liposuction. Other patients may have more volume at the other donor sites of the buttocks or thighs when compared to the abdomen.

In these instances, patients may be candidates for autologous reconstruction from a secondary site. Our commonly preferred secondary sites include the PAP (inner thigh) and SGAP (upper gluteal region) flaps. Just as is performed with the DIEP procedure, both the PAP and SGAP flaps involve harvesting the skin and fat from these various regions along with their respective blood supply to reconstruct a more natural-appearing breast.

Various factors can influence a patient’s candidacy for these secondary flaps, which include having an adequate volume from the donor site. In some instances, you may benefit from a combination implant and autologous reconstruction with a secondary flap. While the incisions can be hidden in clothing, patient acceptance of scar patterns is important for all autologous reconstructive cases.

At Breast Reconstruction Associates, we would be happy to discuss your reconstructive needs and design the best plan using a secondary flap if the DIEP flap is not an option for you. Please call your local Forth Worth, Austin, or Oklahoma City office to schedule a consultation today.

Preparing for DIEP Flap Breast Reconstruction

Written by info@wildmonkeybrand.com on December 15, 2023. Posted in Breast Reconstruction, DIEP Flap Reconstruction.

Patients who have opted for mastectomy with DIEP flap reconstruction often ask what they can do to best prepare for the recovery process. The amount of time between deciding on the right surgery for you and the surgery date varies from patient to patient. Some patients have only a few weeks between their diagnosis and surgery; others have months to years depending on other treatments or life circumstances. In either situation, the following recommendations apply.

1. Maintain a healthy diet

Eating a balanced diet of protein, healthy fats, fruits and vegetables will help you get the proper macronutritents, vitamins and minerals needed for healing and recovery after surgery. Try to minimize your intake of sugar, foods with added sugar, or highly processed foods. These foods can be pro-inflammatory and are unlikely to be nutrient-rich sources of food. Most patients do not need any type of supplements prior to surgery

2. Optimize cardiovascular status

Exercise in the form of aerobic activities (i.e. walking, jogging, biking, etc.) strengthens your cardiopulmonary system to better tolerate surgery and anesthesia, helps control blood pressure, and contributes to a faster post-operative recovery. Some patients have high blood pressure, coronary artery disease or other cardiac issues. It’s important to optimize the management of these issues with your cardiologist prior to surgery. If you have a history of heart problems or are not currently physically active, check with your doctor before beginning exercise routines.

3. Minimize risk factors of surgical complications

Many patient factors that contribute to surgical complications, such as poor wound healing and infection, are modifiable. If you are an active smoker, the best thing you can do for your recovery would be to completely eliminate nicotine use. If you are overweight or have diabetes, it’s also extremely beneficial to lose weight and/or control your blood sugar as much as possible prior to surgery. Talk to your doctor about strategies to reduce risk factors of surgical complications before surgery.

4. Mental preparation

Undergoing breast reconstruction surgery can be stressful mentally and emotionally, especially if you are also processing a new breast cancer or gene mutation diagnosis. Having emotional and spiritual support systems in place in the form of family and friends is also important. You may also find it helpful to have some personal coping mechanisms in place prior to surgery such as journaling, meditation, support groups or prayer. Lastly, it’s important for you to have a positive relationship with your surgeon. Open communication about the surgery, recovery and expectations will help you feel comfortable and confident with your decision to undergo breast reconstruction surgery.

Nipple Reconstruction and 3D Nipple Tattoos

Written by info@wildmonkeybrand.com on November 16, 2023. Posted in Breast Reconstruction, DIEP Flap Reconstruction.

Breast reconstruction surgery is designed to restore the volume and shape of the breast after mastectomy. Some women may be candidates for nipple-sparing mastectomy but in many cases, this part of the breast must be removed. To complete the reconstruction and restore the aesthetic unit of the nipple and areola, women have the option to choose from 3D nipple and areola tattoos vs nipple reconstruction followed by tattooing of the areola pigment.

3D nipple and areola tattoos are done by a professional tattoo artist that specializes in this trade. ‘Before’ photos are reviewed, and careful consideration is given to the color selection, size and placement of the nipple and areola. The pigment is then applied in the form of a tattoo with additional shading techniques to create the appearance of a 3D nipple. This means that in the mirror, the visual aesthetic unit of a nipple is present, but to the touch, the breast is smooth and flat.

Nipple reconstruction followed by NAC tattoos involves a minor procedure of nipple reconstruction that can be done at the time of breast reconstruction, in combination with a second stage revision, or alone as an office procedure. The procedure involves cutting and suturing a small amount of skin into the shape of a nipple with proper placement and symmetry on the breast mound. After this reconstructed nipple has healed, tattoo pigment can be applied to restore the color and shape of the areola. This results in restoration of the visual aesthetic unit of the nipple and areola, as well as the physical projection of a nipple. It is important to note that a nipple reconstruction does not have sensation and will always remain erect.

These procedures are not mandatory but encouraged to achieve the most optimal and the most natural aesthetic result. If you have questions, please consult your breast reconstruction experts of Austin, North Texas and Oklahoma at Breast Reconstruction Associates. You may also find it helpful to review some of our before and after photos. The surgery and completion details are indicated for each photo.

How to Choose Your Plastic Surgeon

Written by info@wildmonkeybrand.com on August 16, 2023. Posted in Breast Implants, Breast Reconstruction, DIEP Flap Reconstruction.

What are the top things to consider when looking for a breast reconstruction surgeon?

1. Credentials.

Your surgeon should be board-certified by the American Society of Plastic Surgeons or the American Board of Medical Specialties.

According to The American Society of Plastic Surgeons (ASPS), it is important to choose a surgeon that has completed the certification requirements of their country. Members of the ASPS meet very strict standards (1):

Board certification by the American Board of Plastic Surgery® (ABPS)
Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
Pass comprehensive oral and written exams
Graduate from an accredited medical school
Complete continuing medical education, including patient safety, each year
Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities

2. Works with your breast surgeon.

Your breast surgeon should have a good working relationship with your plastic surgeon. The two surgeons should communicate frequently and together formulate the best treatment plan for each specific patient. Therefore, it is important that your plastic surgeon is someone your breast surgeon feels comfortable working with. Typically, after a new breast cancer diagnosis, your breast surgeon will help narrow your decision by referring you to one or multiple plastic surgeons that may fit your reconstructive needs.

3. Discuss all of your options.

There are two main types of breast reconstruction, implant-based or autologous based. In the consultation with your plastic surgeon, both types of reconstruction should be discussed so you can fully understand your options. Some patients are better candidates for one type over the other, and your plastic surgeon will be able to provide data supporting why. Keep in mind that not all plastic surgeons specialize in or offer every type of reconstruction procedure there is and therefore you may want or need to consult multiple plastic surgeons.

4. Ease of communication.

Making an informed decision is important. You should feel comfortable asking your surgical team questions until you fully understand the procedure you are planning to undergo. By doing this, you are opening up the communication lines and establishing a good relationship with your doctor.

If you are looking for the best breast reconstruction surgeon for you, consider Breast Reconstruction Associates. They are a team of Fort Worth, Dallas, Oklahoma City, and Austin breast reconstruction surgeons who not only have premier skills and credentials but also have high regard for quality patient care.

Sources:

(1) “How Do I Choose a Plastic Surgeon for Breast Reconstruction?” American Society of Plastic Surgeons, www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction/surgeon.

I’ve Had (or Need) Post-Mastectomy Radiation, What Are My Reconstructive Options?

Written by info@wildmonkeybrand.com on March 3, 2023. Posted in Breast Reconstruction, DIEP Flap Reconstruction, Mastectomy Radiation.

Radiation is a mainstay of treatment for breast cancer and is sometimes required after a total mastectomy. Even though the breast is gone, the chest wall including the skin and underlying pectoralis muscle as well as regional lymph nodes may benefit from radiation. The need for post-mastectomy radiation will be determined by your final surgical stage.

Radiation therapy can pose challenges for implant-based reconstruction as it leads to higher rates of implant failure requiring subsequent surgeries to remove or exchange the implant. Complications after radiation also include pain, delayed healing and infection, and accelerated progression to capsular contracture. In patients who have previously been treated with radiation or know post-mastectomy radiation is planned for a current cancer diagnosis, autologous reconstruction (meaning using tissue from one’s own body) is the preferred approach over implant-based reconstruction.

At Breast Reconstruction Associates, our preferred donor site for autologous reconstruction is the lower abdominal skin and fat (DIEP flap) as enough skin and fat can usually be harvested to reconstruct a breast without the need for an implant. However, there are other donor site options available if you’re not a candidate for the DIEP flap, e.g. previous abdominoplasty. Rarely, an augmentation implant may be combined with your own tissue to complete the reconstruction process.

If you previously underwent a mastectomy without reconstruction followed by chest wall radiation, you can proceed with autologous reconstruction even years later. Autologous reconstruction brings soft, non-radiated skin and fat to the chest wall to help create a new and more natural-appearing breast mound.

For patients with a current breast cancer diagnosis requiring radiation therapy, autologous reconstruction can be done immediately at the time of the mastectomy or in a delayed fashion once all cancer treatments have been completed. This decision is made on a case by case basis between you, your plastic surgeon and breast surgeon. If a delayed approach is considered, then the final reconstruction usually occurs 3 to 6 months after completing radiation therapy.

3 Things You Can Expect After Breast Reconstruction Surgery

Written by info@wildmonkeybrand.com on August 14, 2022. Posted in Breast Reconstruction, DIEP Flap Reconstruction.

Breast reconstruction surgery is a major event in a patient’s life and can be a source of fear or anxiety. At Breast Reconstruction Associates, we want you and your loved ones to feel prepared and supported throughout the entire peri-operative process. Time will be spent with you prior to surgery to review the risks of surgery, the expected hospital course and the details of your post-operative recovery. Here are some basic changes you can expect after DIEP flap breast reconstruction:

1. Swelling

Because of the overall healing response of multiple surgical sites, swelling is normal and expected of the breasts and the abdomen after surgery.
Swelling can take 4-8 weeks to completely resolve.
Compression garments such as a compression bra, shape wear or an abdominal binder can help reduce swelling.
Swelling on one side of the body more than the other (such as one breast vs. the other or one leg vs. the other) warrants a call to your surgeon right away.

2. Scar Tissue

Scars will continue to remodel and mature which changes their appearance for 1 -2 years after surgery.
Topical therapies to improve the appearance of scars can be helpful. Please discuss with your surgeon the best options for you after surgery.
Scar tissue can also cause some tightness and discomfort. This can be improved with stretching, physical therapy or massage therapy of the surgical sites. Your surgeon can discuss this with you after surgery if needed.
We do our best to position scars in locations generally covered by most clothing/swimwear.

3. Sensory Changes

Its normal to experience numbness of the breast mound and around the central part of the abdominal incision.
Sensation can return to surgical site areas, but generally only partial return of sensation is achieved. If sensation has not returned after 6-12 months, the numbness is likely permanent.
Sensory changes can make it difficult to detect if something is too hot or too cold which is why we discourage the use of ice packs or heating pads.
We prefer you wait until you are 12 weeks post op to wear an underwire bra. Until that time, you may wear a post-surgical compression bra or a well-fitted sports bra.

How Radiation Therapy Affects Breast Reconstruction

Written by info@wildmonkeybrand.com on May 13, 2022. Posted in DIEP Flap Reconstruction.

Radiation therapy is a common tool available in the treatment of some breast cancers. Most commonly, radiation therapy is part of the treatment for patients who undergo a lumpectomy, or “partial” mastectomy. In these cases, radiation is done to the remaining breast tissue to lower the chance of recurrence. Radiation can also serve a role in some patients undergoing a mastectomy, usually when the following criteria are met:

Larger tumor sizes
Axillary lymph node involvement with the cancer
Close surgical resection margins

Radiation can impact the size, shape, volume and/or projection of the breast, and it can also impact the quality and character of the breast and chest wall skin in the treatment field. All of these factors are considered when planning for breast reconstruction.

Timing of reconstruction is very important, as reconstruction can have an impact on breast cancer treatment. Due to the sensitivity of the treatment schedule, your reconstructive surgeon will often work in coordination with your medical and radiation oncologists to determine optimal timing for reconstruction.

Depending on the circumstance, radiation can be done either before or after reconstruction. Each patient scenario is unique, so you should ask your reconstructive surgeon about the optimal timing of reconstruction, specific to your case. Importantly, the method of reconstruction will have a significant impact on when the reconstruction is done relative to radiation treatment. An experienced reconstructive surgeon will choose a plan that is safe, but that also optimizes the aesthetics of your outcome.

In our practice, when radiation therapy is required, we try to avoid the use of implants for reconstruction. In mastectomy patients who require (or who have had) radiation, DIEP flap reconstruction is the safest approach. The surgery involves using the patient’s own tissue to reconstruct the breast. The result is a soft, natural, long-lasting result, despite the need for radiation.

Breast Reconstruction Associates specializes in DIEP flap surgery. Please do not hesitate to contact us for more information. Scheduling a consultation is simple and allows us to better discuss your situation.

DIEP Flap vs. Implant Breast Reconstruction

Written by info@wildmonkeybrand.com on March 15, 2022. Posted in Breast Reconstruction, DIEP Flap Reconstruction.

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 procedure is available at Breast Reconstruction Associates, your DIEP flap providers in Dallas Fort Worth, Texas. Our goal is simple: we offer a state-of-the-art breast reconstruction option to women through a team approach of individualized and compassionate care.

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.

Sources:

https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/diep

Get Your Breast Reconstruction Questions Answered

Written by info@wildmonkeybrand.com on January 17, 2022. Posted in Breast Reconstruction, DIEP Flap Reconstruction.

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.