Monday, March 7, 2011

Finding the Best DIEP Flap Surgeon for You

If you are considering DIEP flap breast reconstruction, finding the right surgical team is key. Before deciding which surgeon is the best DIEP flap surgeon for you, consider asking the following questions:
  1. Are you certified by the American Board of Plastic Surgery? Your surgeon should be a board certified plastic surgeon with extensive training and experience in microsurgery.
  2. How much experience do you have with this type of surgery - How many have you 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 rate of at least 98%.
  4. How long does the surgery take? This will vary between institutions based on experience. The most experienced surgeons typically take between 3-6 hours depending on whether one or both breast are being reconstructed (not including the mastectomies).
  5. How often do you plan to perform a DIEP flap but end up changing the procedure to a free TRAM flap during the surgery? The "conversion rate" to a free TRAM flap should be very low.
  6. How many microsurgeons will be performing the surgery? Since the DIEP flap procedure can be so technically demanding, it is preferable to have two microsurgeons performing the surgery rather than just one. Not only will this ensure you benefit from the expertise of two specially trained surgeons, but it will also significantly cut down the length of the procedure and anesthesia time.
  7. Do you have residents or fellows? Will they be performing any of my surgery? Some centers have surgeons-in-training known as "residents" or "fellows" that may be helping with your surgery or even performing part of it. This may or may not be something you are comfortable with considering the complexity of the surgery. 
  8. Do you "balance bill"? Centers like PRMA that are in-network for most insurance plans will ask the patient to pay ONLY what's laid out by the patient's insurance plan (ie copay, deductible, etc). Other centers "accept insurance" and will often help the patient get money back from their insurance company - however, the patient is still expected to provide the difference between what the insurance pays and the doctor's fee. This is known as "balance billing". Make sure to ask ahead of time to avoid nasty financial surprises down the line.
  9. Do you have Insurance Specialists on staff? Unfortunately, some patients will face difficulties in gaining access to DIEP flap specialists even though insurance companies are federally mandated to pay for the cost of breast reconstruction. Here again it pays to seek out centers that specialize in these procedures as typically an insurance specialist is available to help patients with insurance issues. Again, this can prevent a nasty financial surprise after your surgery.
    Hope that helps!

    Dr C


    PRMA Plastic Surgery has successfully performed several thousand microsurgical breast reconstructions, and typically performs over 500 DIEP flaps per year. We specialize in advanced breast reconstruction procedures that use the patient's own tissue. Procedures offered include the DIEP flap, SIEA flap, GAP flap, and TUG flap. We are In-Network for most US insurance plans. Patients are routinely welcomed from across and outside the USA. Connect with other breast cancer reconstruction patients at

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