Who is NOT a DIEP flap candidate?

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 contra-indication 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 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).

I hope this info helps.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, Texas specializing in state-of-the-art reconstructive breast surgery. He and his partners at PRMA are In-Network for most major US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients on Facebook.

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5 Tips To Boost Healing After Surgery

Surgery is stressful enough without having to deal with wound healing complications afterwards. Maximize your chances of healing well by following these 5 tips:

1. Increase pro-healing nutrients in your diet:
Wounds need a lot of energy to heal well. Since energy can only come from food, it is vital that patients eat as healthily as possible especially before and after surgery. Crucial nutrients for wound healing include protein, zinc and vitamins A and C.

So what are the best things to eat? Meats, nuts, beans and dairy products are great sources of protein. Carrots, tomatoes, sweet potatoes, spinach and apricots are great sources of vitamin A. Citrus fruits and green leafy vegetables are great sources of Vitamin C. Yogurt, green peas, beef, oysters, black beans and crab are great sources of zinc.

2. Drink plenty of water:
Patients must also stay well hydrated before and after surgery by drinking plenty of water. Moisture is needed for normal wound healing. Dehydration causes the skin and soft tissues to lose moisture and this in turn can delay healing.

3. If possible get to a healthier weight:
The importance of healthy nutrition is really emphasized by the link between obesity (Body Mass Index [BMI] over 30) and complication rates after surgery. Obese patients have much higher rates of infection, wound healing problems (breakdown of wounds), hematomas (blood collections), and seromas (fluid collections) compared to non-obese patients.

Obese patients also have a thicker subcutaneous adipose layer with a poorer blood supply. Blood flow to the healing tissues is therefore less robust and the amount of vital nutrients and oxygen reaching these tissues are far less than in non-obese patients. This poor blood flow compounds the negative effects of poor nutrition. If possible, losing weight before surgery will only decrease the risk of complications.

4. Stop smoking:
Smoking can also really impact healing. The nicotine in cigarette smoke causes blood vessels to shrink, so again tissues do not receive enough of the nutrients and oxygen required for healing. At best, this can cause the wound healing process to take much longer. At worst, smoking can cause wounds to breakdown. Unfortunately, many smoking-cessation products will also increase the risk of healing problems because of the nicotine they contain!

Cigarette smoke also contains carbon monoxide. This combines with your blood cells preventing them from carrying oxygen and effectively lowering the level of oxygen in the blood. Since oxygen is vital for healing, it is crucial to quit smoking before and after surgery to decrease the risk of healing complications.

5. Exercise:
Another good thing to do?... Exercise. Regular aerobic exercise improves healing after surgery and boosts the immune system. Start with walking and progressively build up to more of a sweat once given the "all-clear" by your surgeon.

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Dr Chrysopoulo is a board certified plastic surgeon and microsurgeon specializing in breast cancer reconstruction. He is in-network for most major US insurance plans and routinely treats patients traveling from across the US for breast reconstruction. To schedule a consultation please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com. Connect with Dr C on Twitter and Facebook.

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