Myths About DIEP Flap Breast Reconstruction
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1. Myth: DIEP flap surgeries are risky and dangerous
When performed by experienced physicians, DIEP flaps are no more risky than other types of breast reconstruction, such as free TRAM flaps. The success rates for these operations in our experience is equivalent.
However, DIEP flaps have been shown to have less postoperative complications in the abdomen, less postoperative pain and faster recovery times than the older TRAM flap procedures. This is because the DIEP and flap spares the rectus abdominis (belly “six pack”) muscle in contrast to the TRAM flap. The flap failure rate for DIEP and free TRAM flaps is equally low in our experience.
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2. Myth: DIEP flaps have more complications than other types of breast reconstruction
Any type of surgery, including surgery for breast reconstruction, carries some element of uncertainty and risk. However, published medical studies have repeatedly shown that DIEP flap breast reconstructions tend to have less complications than other types of breast reconstruction.
Patients with tissue expander / breast implant reconstructions are between 4 and 5 times more likely to require one or more additional, unplanned surgeries in the operating room in the first 5 years after their breast reconstruction, with this number continuing to increase with time. This risk is even higher for patients who require radiation therapy as part of their breast cancer treatment.
The data in the table below are taken from the INAMED breast implant study which was mandated of breast implant manufacturers by the U.S. Federal Government.
Complications of Breast Reconstruction with Tissue Expanders / Implants |
|
|
3 Year Rate |
5 Year Rate |
7 YearRate |
|
|
39 % |
45 % |
49 % |
Asymmetry |
33 % |
39 % |
- |
Capsular Contracture III/IV |
25 % |
36 % |
43 % |
Implant Replacement / Removal |
23 % |
28 % |
31 % |
Deflation |
6 % |
8 % |
12 % |
| |
In contrast, 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 less than 10%.
Complications of DIEP Flaps |
| Unplanned reoperation |
5.9 % |
| Hernia |
0.5 % |
| Partial Flap Loss |
2.5 % |
| Total Flap Loss |
0.5 % |
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. Myth: My doctor will be offended if I ask specific questions about DIEP flaps and which experienced doctors perform them
Physicians are specifically trained to communicate with and educate their patients about their procedures. It is a patient's right and responsibility to ask their physician any and all questions about their surgical and other treatment options. It would be extremely unusual for a properly trained and Board Certified Plastic Surgeon to be offended at any questions regarding their experience with DIEP flaps or any other procedure.
Questions you should ask your doctor about DIEP flap breast reconstruction:
1. What types of breast reconstruction do you most commonly perfor?
2. How many DIEP flap procedures have you performed?
3. Who is the assistant surgeon likely to be?
4. How often do you convert a DIEP flap to a free-TRAM flap?
5. Have you had fellowship training in DIEP flap microsurgery? If so, where?
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4. Myth: Most plastic surgeons routinely perform DIEP flap surgery
Most plastic surgeons do not perform DIEP flap surgery or any other type of microsurgery on a routine basis. While many physicians and websites give mention to the procedures or perform them infrequently, only a small handful of sugeons perform DIEP flaps routinely as part of their practice.
In fact, most Plastic Surgery training programs do not have a significant exposure to DIEP flaps at all. The most commonly taught procedures are still implant reconstruction and pedicled and/or free TRAM flap surgery for breast reconstruction.
Certain, specialized centers focus on advanced microsurgery and provide residency and/or fellowship training in DIEP and perforator flap microsurgery.
Most physicians who rountinely perform DIEP and/or GAP flaps have had additional fellowship training with these procedures.
Click here for a more detailed description of microsurgery.
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5. Myth: I cannot have a DIEP flap operation because no surgeon in my area performs the procedure
While most surgeons do not routinely perform DIEP flap breast reconstruction, it is common for patients to travel to see a surgeon who does these advanced procedures. Our office is accustomed to taking care of patients out-of-town patients that require DIEP flap breast reconstruction.
Insurance companies typically must grant an out-of-network referral to allow a patient to see a specialist who can perform the procedure they require if it is not available within a reasonable distance of their home.
We also maintain strong relationships with excellent breast cancer surgeons should our patients require a mastectomy as part of their treatment.
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6. Myth: There is no way that my insurance company will help pay for my DIEP flap surgery
Patients may not be aware that Federal Law and State Laws require insurance coverage for breast reconstruction and for surgery to the opposite breast for symmetry.
Because expander/implant or other older methods of breast reconstruction, such as TRAM flaps tend to be cheaper to pay for, insurance companies will typically be happier to have patients pursue these options. This is especially true in most areas as most DIEP flap surgeons are out-of-network for most insurance plans.
Our office, while also out-of-network, does take insurance as an out-of-network provider and will work closely with you and your insurance company to minimize the out-of pocket costs of surgery. We have extensive experience with most insurance companies. Please contact our office for more information specific to your coverage.
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7. Myth: Because I am thin there is no way I can have a DIEP flap or other type of perforator flap breast reconstruction
Because most thin patients are proportionate with respect to their breast and abdomen, many thin patients will have sufficient abdominal tissue to reconstruct at least one breast. Additional options, such as GAP flaps, are also available. Patients are invited to check our photo gallery for examples of thin patients who have had great, natural appearing breast reconstructions with DIEP flaps. Please contact our office for more information.
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8. Myth: Even though I have had problems with my breast implant reconstruction I cannot have a DIEP flap because my insurance only covers one procedure
Insurance may cover much or all of the costs assiciated with the replacement of an old breast reconstruction implant with your body's own tissue. Please contact our office for more information.
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9. Myth: The recovery after DIEP flap breast reconstruction is worse than with other types of breast flap reconstruction
The recovery for DIEP flap patients is typically better than that of TRAM flap patients. Almost always the abodminal pain is less, patients are up and about more quickly and the overall recovery time is shorter that patients that have had TRAM flaps.
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10. Myth: A DIEP flap often must be converted to a free TRAM procedure in surgery to "be safer"
Dr. Granzow's method of retrieving the flap vessels is simliar to that used by other experienced DIEP flap surgeons in the United States and overseas and rarely requires conversion of a DIEP flap to a free TRAM flap. In our experience less than 5% of patients must have their DIEP flap converted to a muscle-sparing free TRAM flap. The vast majority of these are due to the presence of previous abdominal surgery and scarring in the vessels required for the procedure.
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11. Myth: DIEP flaps can only be performed at large, academic centers with residents and fellows
We have routinely performed DIEP flaps in our community hospitals without the assistance of residents or fellows for years. Our success rate is equivalent or better than that of most large, academic centers. We find our patients appreciate the more personal care and service of our hospitals and most patients recieve their own rooms during their postop stay.
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12. Myth: Aren't the results of all the different types of breast reconstruction the same?
They are not the same! A breast reconstruction performed with a patient’s own tissues results in a breast simply 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.
Furthermore, DIEP flap operations consistenly have been shown in published medical studies to have a better result in the abdominal donor site as well.
Photos can be taken and placed in print or on websites which make breasts reconstructed with implants appear equivalent to breasts reconstructed with a patient's own tissue. This is especially true if only 1 or 2 views are seen. For this reason we present multiple, consistent views of our patients from multiple angles to give the best 2-dimensional representation of the 3-dimensional results.
In our experience, no patient that has had implants replaced with their own, natural tissue has liked the implant better or wished to have it back!
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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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