Frequently Asked Questions
Click on the appropriate question below or scroll down on the webpage for answers to Frequently Asked Questions.
1.What are the advantages of the DIEP and SIEA flaps over other methods of breast reconstruction using the patient’s own tissue?
In contrast to the TRAM flap, both the DIEP and SIEA flaps spare the rectus abdominis (belly “six pack”) muscle. They use almost the same abdominal tissue normally removed and discarded in a typical abdominoplasty (tummy tuck) to create a new, more natural appearing breast.
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2. What are the advantages of the DIEP and SIEA flaps over breast reconstruction with tissue expanders and implants?
Breast reconstruction performed with a patient’s own tissues results in a breast that is more natural in feel and appearance. The breast will grow, shrink and change like the rest of the body with natural aging and weight gain and loss.
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3. How do the complication rates compare between breast reconstructions performed with perforator flaps and those performed with tissue expanders and implants?
Published studies have shown that long term complication rates for perforator flaps, such as DIEP flaps, have been shown repeatedly to be much lower than when tissue expanders and implants are used. Previous studies of DIEP perforator flaps reveal an unplanned surgical revision rate of approximately 10%.
Procedures using expanders and implants tend to have quicker initial surgeries but higher rates of long term complications. They are commonly performed and fall within the standard of care for breast reconstruction. Nationally collected data for breast reconstructions performed with tissue expanders and implants showed an unplanned surgical revision rate of 45% - 49% over 5 years. The rate of complications with patients with implant reconstructions who have had previous radiation therapy is even higher.
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4. What is microsurgery and why is it important for breast reconstruction?
Microsurgery allows the movement of large amounts of tissue from one part of the body to another. It has revolutionized field of Reconstructive Plastic Surgery and gives a skilled microsurgeon a much wider range of options than ever before possible. This makes it possible for a microsurgeon performing a perforator flap to transfer the abdominal skin and fat needed for a breast reconstruction without sacrificing the abdominal muscle. The use of tissue from the buttock for breast reconstruction is only possible with microsurgical techniques.
Click here for a more detailed description of microsurgery.
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5. What are the risks of surgery?
Any surgery performed in any hospital or surgery center carries the risk of complications. The chances of such a complication occurring are low but not zero. The only way to have no risk of complications is to not have breast reconstruction, which is an option. Standard surgical risks include bleeding, infection, pain, damage to nerves and blood vessels, partial of complete flap loss if flaps are done, permanent scars, and the need for revision surgery. These risks are common to all physicians performing breast reconstruction or other surgery. Each type of procedure has its specific set of risks. We will carefully go over any risks involved before your procedure and are happy to answer any questions or concerns you might have at any time.
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6. What if I smoke or often am around people who smoke ?
Smoking is not only very bad for your heart, lungs, skin, appearance, and health in general, but is also extremely bad for breast reconstruction procedures. Smoking tobacco or other substances causes vasoconstriction, or the clamping down, of blood vessels and may result in the failure especially of a microsurgical flap. This includes both active and passive (second hand) smoking. Smokers tend to have higher rates of complications with all types of surgery, including breast reconstruction. If you smoke or are often around people who smoke and are considering any type of breast reconstruction you should stop smoking immediately. We require patients being considered for microvascular breast reconstruction to stop smoking for a minimum of 4 weeks prior to surgery and 6 weeks after surgery. Patients who cannot stop smoking should not have microsurgical breast reconstruction.
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7. How much will the surgery cost?
Medical necessities and insurance coverage make each situation unique. We rountinely perform DIEP flap breast reconstruction and are very familiar with the insurance companies and their issues. If necessary, our office will spend significant amounts of time, make telephone call and write letters on behalf of our patients. Please call our office to review your situation.
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8. How long after the initial consultation can surgery be scheduled?
Scheduling can begin on the day of consultation, but the final date will come after insurance authorization. We will carefully coordinate arrangements for patients traveling from out-of-town.
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9. How long will I stay in the hospital?
Four to five days is average for microsurgical breast reconstruction, although the length of stay may vary according to each surgery and patient.
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10. When can I shower?
Before you leave the hospital.
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11. When is the first follow up visit?
One week after surgery.
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12. When will I be able to move around?
You should not lift your arms for one week. After that you must not carry weight that exceeds that of a grocery bag for three weeks.
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13. How soon can I return to work?
Four to six weeks is typical depending on your occupation.
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14. When will I have my second stage procedure?
If required, the second stage procedure takes place about 8 to 12 weeks after the first surgery.
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15. How long will I stay in the hospital for the second stage procedure?
Typically one night, although it may be performed as an outpatient procedure in many cases as well.
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16. When will I have a nipple reconstructed?
Usually three months after the initial surgery.
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17. When can the nipple be tattooed?
One month after nipple construction.
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18. Do I have to be admitted to the hospital for nipple construction?
This can be an inpatient or outpatient office procedure.
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