Cancer

DIEP flap? TRAM flap? SIEA flap? With in addition to then many pectus reconstruction options available these days it's hard to empathise what these price actually hateful in addition to what the differences are betwixt all these "tummy flap" procedures.

It is of import for women considering these reconstructive options to realize that non all tum tissue options are created equal. For example, a DIEP flap is non the same every bit a TRAM flap only because both provide the exercise goodness of a tum tuck.

Many women are similar a shot rejecting pectus implants preferring to role their ain abdominal tissue for reconstruction subsequently mastectomy. Influenza A virus subtype H5N1 pectus that has been reconstructed alongside the patient's ain tissue typically looks in addition to feels to a greater extent than natural than an implant reconstruction, volition final longer without the long-term complications that tin give the sack live associated alongside implants, in addition to volition every bit good historic menses similar a natural breast. Women wanting to role their abdominal tissue convey iii reconstructive options: TRAM flap, DIEP flap, or SIEA flap.

The TRAM flap is a real mutual pectus reconstruction technique that requires the sacrifice of at to the lowest degree a constituent of the rectus abdominus (sit-up) muscle. There are iii dissimilar types of TRAM flap ("pedicle", "free", in addition to "muscle-sparing free"): the exact type is defined past times the sum of abdominal musculus removed. Unfortunately, TRAM surgical operation tin give the sack live associated alongside meaning post-operative pain, prolonged recovery in addition to a host of abdominal complications such every bit loss of abdominal musculus describe (up to 20% or more), bulging (or "pooching"), in addition to fifty-fifty abdominal hernia.

The DIEP flap physical care for is similar to the TRAM flap except that it spares the rectus abdominus musculus completely. Only pare in addition to obese are removed from the abdomen. This tissue is disconnected from the trunk completely, transplanted to the pectus in addition to re-connected using microsurgery to exercise the novel breast. As the sit-up musculus is saved completely in addition to left behind inwards its natural place, the jeopardy of abdominal complications is much less than alongside a TRAM. There every bit good tends to live less hurting in addition to a quicker recovery fourth dimension because the abdominal muscles are preserved in addition to left inwards place.

Like the DIEP flap, the SIEA (Superficial Inferior Epigastric Artery) flap completely preserves the abdominal muscles. The primary divergence betwixt these 2 procedures is the artery used to provide blood current to the newly reconstructed breast. The “SIEA” blood vessels are to a greater extent than often than non works life inwards the obese tissue only below pare whereas the “DIEP” blood vessels run below in addition to inside the abdominal musculus (making the DIEP to a greater extent than technically challenging). Recovery from the SIEA flap is fifty-fifty easier than the DIEP since the abdominal muscles are non disturbed at all during the surgery.

Despite the similarities betwixt these 2 surgeries the SIEA flap is used much less ofttimes than the DIEP flap because less than 20% of patients convey the appropriate anatomy. Unfortunately, at that topographic point are no pre-operative tests to reliably exhibit which patients convey the appropriate anatomy in addition to the conclusion every bit to which physical care for to perform is made intra-operatively past times the plastic surgeon based on the anatomy works life at the fourth dimension of surgery.

Since the TRAM, DIEP in addition to SIEA procedures all role the patient's lower abdominal pare in addition to fat, all these abdominal flap options provide the added exercise goodness of a tum tuck at the same fourth dimension every bit the pectus reconstruction.

There are many plastic surgeons inwards the US offering TRAM flap reconstruction. Unfortunately, real few centers inwards the US routinely perform the advanced microsurgical procedures similar the DIEP in addition to SIEA flap. Many patients volition hence convey to move for these procedures.

When considering a reconstructive surgeon, ensure he/she is a plastic surgeon certified past times the American Board of Plastic Surgery that has extensive experience alongside this specific type of surgery. Also inquire close the success charge per unit of measurement inwards their hands - most specialists boast a flap survival charge per unit of measurement of 97% to 99%+.

The 2 websites below listing surgeons that offering DIEP in addition to SIEA flap reconstruction in addition to serve every bit a adept starting indicate when researching surgeons:


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Dr Chrysopoulo is a board certified plastic surgeon at PRMA Plastic Surgery. PRMA specializes inwards microsurgical pectus reconstruction including the DIEP flap procedure. PRMA has performed thousands of DIEP flaps in addition to is In-Network for most US insurance plans. On Facebook?.... Connect alongside other pectus cancer patients inwards our FB Breast Cancer Reconstruction Community.

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If y'all are considering DIEP flap thorax reconstruction, finding the correct surgical squad is key. Before deciding which surgeon is the best DIEP flap surgeon for you, consider bespeak the next questions:

1. Are y'all certified past times the American Board of Plastic Surgery? Your surgeon should live a board certified plastic surgeon amongst extensive preparation together with sense inwards microsurgery.
2. How much sense create y'all cause got amongst this type of surgical operation - How many cause got y'all performed? It is preferable that your surgeon has successfully performed over 100 DIEP flap reconstructions.
3. What's your success rate? Top specialist centers boast a success charge per unit of measurement of at to the lowest degree 98%.
4. How long does the surgical operation take? This volition vary betwixt institutions based on experience. The nearly experienced surgeons typically bring betwixt 3-6 hours depending on whether i or both thorax are beingness reconstructed (not including the mastectomies).
5. How oftentimes create y'all conception to perform a DIEP flap but destination upward changing the physical care for to a gratuitous TRAM flap during the surgery? The "conversion rate" to a gratuitous TRAM flap should live rattling low.
6. How many microsurgeons volition live performing the surgery? Since the DIEP flap physical care for tin plow over the sack live together with then technically demanding, it is preferable to cause got ii microsurgeons performing the surgical operation rather than only one. Not exclusively volition this ensure y'all create goodness from the expertise of ii particularly trained surgeons, but it volition likewise significantly cutting downward the length of the physical care for together with anesthesia time.
7. Do y'all cause got residents or fellows? Will they live performing whatever of my surgery? Some centers cause got surgeons-in-training known every bit "residents" or "fellows" that may live helping amongst your surgical operation or fifty-fifty performing business office of it. This may or may non live something y'all are comfortable amongst considering the complexity of the surgery. 
8. Do y'all "balance bill"? Centers similar PRMA that are in-network for nearly insurance plans volition enquire the patient to pay ONLY what's pose out past times the patient's insurance conception (ie copay, deductible, etc). Other centers "accept insurance" together with volition oftentimes assist the patient travel coin dorsum from their insurance fellowship - however, the patient is soundless expected to furnish the departure betwixt what the insurance pays together with the doctor's fee. This is known every bit "balance billing". Make certain to enquire ahead of fourth dimension to avoid nasty fiscal surprises downward the line.
9. Do y'all cause got Insurance Specialists on staff? Unfortunately, roughly patients volition expression upward difficulties inwards gaining access to DIEP flap specialists fifty-fifty though insurance companies are federally mandated to pay for the toll of thorax reconstruction. Here over again it pays to assay out centers that specialize inwards these procedures every bit typically an insurance specialist is available to assist patients amongst insurance issues. Again, this tin plow over the sack preclude a nasty fiscal surprise afterwards your surgery.

Hope that helps!

Dr C

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Alarmingly, 70% of American women facing surgical operation for pectus cancer are non told virtually the selection of pectus reconstruction.

Perhaps i of the best things virtually pectus reconstruction is that it tin dismiss live performed at whatever time….  you tin dismiss never “miss the boat” so to speak. Regardless of the timing of the procedure, pectus reconstruction enables women to experience whole again, non simply physically but likewise emotionally.

There are several reconstructive options ranging from pectus implants to using the patient’s ain tissue. Tissue (or “flap”) procedures recreate a “natural”, warm, soft pectus in addition to are associated amongst fewer complications than pectus implants.

Breast reconstruction tin dismiss live performed at the same fourth dimension every bit the mastectomy ("immediate reconstruction") or whatever fourth dimension subsequently mastectomy ("delayed reconstruction"). 
When the mastectomy in addition to reconstruction are performed at the same time, a skin-sparing mastectomy tin dismiss commonly live performed which saves most of the natural pectus peel envelope. Only the actual pectus tissue nether the peel is removed. The reconstruction so "fills" this empty peel envelope. In about cases nipple-sparing mastectomy tin dismiss live performed. This preserves the nipple in addition to areola every bit good every bit all the pectus skin.



Skin-sparing (and nipple-sparing) mastectomy in addition to immediate pectus reconstruction arrive at the most "natural" results amongst the to the lowest degree scarring. Patients undergoing immediate reconstruction likewise avoid the experience of a apartment pectus altogether. Immediate reconstruction is thence preferred whenever possible in addition to should live the destination for patients amongst early on pectus cancer (stage I or II).

In about cases pectus reconstruction cannot live performed at the same fourth dimension every bit the mastectomy. Reasons include advanced pectus cancer (stage III or IV), inflammatory pectus cancer, the invention for radiations therapy subsequently mastectomy, in addition to lack of access to a reconstructive plastic surgeon.

As I already mentioned at the starting fourth dimension of this post, most women unfortunately are non made aware of their pectus reconstruction options. I thence encourage all women interested inwards pectus reconstruction to enquiry their options in addition to try a referral or consultation amongst a plastic surgeon specializing inwards pectus reconstruction.

You tin dismiss run across existent patient results subsequently immediate in addition to delayed pectus reconstruction inwards our photo gallery here.

Dr C


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Most women facing mastectomy as well as thorax reconstruction desire to know what form of feeling their novel breast(s) volition have.

Unfortunately mastectomy leaves many women alongside rattling trivial feeling long term (if any), regardless of whether they convey thorax reconstruction or not.

There is or as well as then adept intelligence though.... Most women undergoing DIEP or SIEA flap thorax reconstruction are too candidates for reconstruction of the sensory nerves inwards the breasts that render feeling. The feeling inwards the novel thorax won't live every bit adept every bit what Mother Nature provided but it's for sure a lot ameliorate than the alternative. H5N1 overnice bonus at the rattling least.

Once the tum tissue (flap) is moved upward to the breast, a sensory nervus inwards the flap is connected microsurgically to a thorax nervus inwards the thorax that was cutting past times the mastectomy. New nervus cells grow from the thorax nervus into the flap nervus over fourth dimension allowing the reconstructed thorax to prepare feeling.

If you're feeling brave, here's a curt video clip of how the 2 nerves are connected. You tin too run across the pulse inwards the blood vessel connections to the novel breast:


I promise this information helps.

Dr C

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With to a greater extent than women becoming aware of DIEP flap thorax reconstruction every bit an option, the inquiry of who is in addition to who isn't a skilful DIEP flap candidate is coming upwards to a greater extent than often.

As a full general rule, women that accept had extensive abdominal surgical physical care for like a previous TRAM flap, stomach tuck or a complex hernia repair cannot accept a DIEP or SIEA flap thorax reconstruction. This is because the lower stomach tissue that is needed has ordinarily been removed or moved around, in addition to the necessary blood render has been disrupted.

Having said that, most of the fourth dimension previous abdominal surgical physical care for isn't an number inwards experienced hands.

Many women these days accept had at to the lowest degree ane previous c-section or roughly other gynecologic physical care for similar a hysterectomy. It is possible for these procedures to campaign harm to the blood vessels needed for DIEP flap surgical physical care for but fortunately this is unusual. H5N1 previous c-section, hysterectomy, or tubal ligation is non a contra-indication to having a DIEP or SIEA flap. Previous liposuction is non ordinarily a occupation either unless this was extensive.

If your surgeon is worried close potential harm from previous surgical physical care for in addition to thus for certain tests tin live performed to evaluate your anatomy to a greater extent than closely. This tin include a unproblematic doppler ultrasound seek out inwards the purpose or a to a greater extent than involved seek out similar a CT angiogram. Unfortunately, the CT scan does involve radiation.

While previous abdominal surgeries may non forbid yous having DIEP flap reconstruction, women that accept had multiple previous abdominal procedures are at increased adventure of abdominal complications similar bulging in addition to hernia later DIEP flap surgical physical care for when compared to women that accept never had prior abdominal surgery, fifty-fifty though the abdominal muscles are preserved. This is because the fascia (the strong layer of tissue over the muscles) has already been weakened past times the previous surgeries.

Some medical issues tin brand whatever bird of microsurgical thorax reconstruction (like the DIEP flap) to a greater extent than hard in addition to they tin every bit good increment the adventure of complications similar flap loss. These include disorders that brand the blood clot to a greater extent than easily (eg Factor V Leiden).

I promise this information helps.

Dr C

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