Considering a DIEP or SIEA flap for your breast reconstruction after mastectomy? You probably already know that to do so, you need to have enough tummy fat to construct your new breast. But did you also know that in some cases, previous abdominal surgeries may preclude you from having a DIEP or SEIA flap? The following guest blog by Dr. Minas Chrysopoulo sheds light on who is and who is not a good candidate for a DIEP/SIEA procedure.
With more women becoming aware of DIEP flap breast reconstruction as an option, the question of who is and who isn't a good DIEP flap candidate is coming up more often.
As a general rule, women that have had extensive abdominal surgery like a previous TRAM flap, tummy tuck or a complex hernia repair cannot have a DIEP or SIEA flap breast reconstruction. This is because the lower tummy tissue that is needed has usually been removed or moved around, and the necessary blood supply has been disrupted.
Having said that, most of the time previous abdominal surgery isn't an issue in experienced hands.
Many women these days have had at least one previous c-section or another gynecologic procedure like a hysterectomy. It is possible for these procedures to cause damage to the blood vessels needed for DIEP flap surgery, but fortunately this is unusual. A previous C-section, hysterectomy, or tubal ligation is not a contraindication to having a DIEP or SIEA flap. Previous liposuction is not usually a problem either unless this was extensive.
If your surgeon is worried about potential damage from previous surgery, then certain tests can be performed to evaluate your anatomy more closely. This can include a simple Doppler ultrasound exam in the office or a more involved test like a CT angiogram. Unfortunately, the CT scan does involve radiation.
While previous abdominal surgeries may not prevent you from having DIEP flap reconstruction, women that have had multiple previous abdominal procedures are at increased risk of abdominal complications like bulging and hernia after DIEP flap surgery when compared to women that have never had prior abdominal surgery, even though the abdominal muscles are preserved. This is because the fascia (the strong layer of tissue over the muscles) has already been weakened by the previous surgeries.
Some medical issues can make any form of microsurgical breast reconstruction (like the DIEP flap) more difficult and they can also increase the risk of complications like flap loss. These include disorders that make the blood clot more easily (eg Factor V Leiden).
MInas Chrysopoulo, M.D. of The Center for Advanced Breast Reconstruction provides breast reconstruction, including DIEP flaps, in San Antonio, TX.