DIEP flap reconstruction uses abdominal fat and skin to create new breasts after mastectomy. But what if a woman who is facing unilateral mastectomy and prefers not to use breast implants for her reconstruction doesn’t have enough fat for natural tissue reconstruction?
Very thin women are often advised that they “don’t have enough fat” in their abdomen, even to reconstruct a single breast, but an innovative variation of the DIEP flap can provide a very workable solution. A stacked DIEP, sometimes also referred to as a double DIEP, combines skin and fat from both sides of the abdomen to create one reconstructed breast.
A stacked DIEP is essentially two separate DIEP procedures. It involves harvesting two abdominal tissue flaps—as if a bilateral reconstruction were being performed—each with its delicate supply of blood vessels. The two DIEP flap tissues are then “stacked” on top of each other to create the new breast. (In some stacked DIEP procedures, a single flap from the width of the abdomen is harvested and then folded over.) The procedure is difficult, because the blood vessels from both flaps must either be connected to each other or to an internal artery in the chest. The flaps are then shaped into the new breast. The opposite healthy breast can be lifted, reduced or augmented for better symmetry. (Harvesting tissue from both sides of the abdomen eliminates the tummy as a donor site for any future reconstruction.)
In addition to very thin women, stacked DIEP can provide a viable reconstructive option for those who have a midline abdominal scar from a previous cesarean section, hysterectomy, or bowel surgery.
As with any surgery, a surgeon’s experience with stacked DIEP is vitally important. See our listing of DIEP surgeons to locate a physician who is experienced with stacked DIEP (you might want to contact any surgeon who is listed as performing DIEP, since our listing may not reflect stacked DIEP if it has been recently added stacked DIEP to their repertoire.)