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

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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 www.facebook.com/PRMAplasticsurgery.

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The Hype Around DIEP Flap Breast Reconstruction And How To Find A DIEP Flap Surgeon

If you are a woman facing mastectomy you have a decision to make: do I want breast reconstruction? If the answer is “yes”, plastic surgery holds the key. Although reconstruction cannot replace the breast(s) you were born with or allow you to breastfeed, it can restore your natural silhouette and make you feel “whole” again following mastectomy.

Depending on your health, breast reconstruction can be performed immediately after your mastectomy surgery so you can wake up with new breasts already in place. While the cosmetic results with immediate reconstruction are generally superior, breast reconstruction can also be performed at a later time once the cancer treatment has been completed.

The DIEP flap breast procedure is today’s gold standard in breast reconstruction. Advances in breast reconstruction have made it possible to use excess skin and fat from the abdomen (rather like the tissue removed during a tummy tuck) to construct a new breast without the need for implants or the sacrifice of abdominal muscle. This procedure, known as the Deep Inferior Epigastric Perforator (DIEP) flap, is a sophisticated modification of an existing procedure known as the TRAM (Transverse Rectus Abdominus Myocutaneous) flap.

TRAM flap surgery is a common breast reconstruction technique that requires the rectus abdominus (sit-up) muscle to be sacrificed and relocated to the upper abdomen. Unfortunately, this technique can be associated with significant post-operative pain, prolonged recovery, loss of abdominal muscle strength (up to 20%), abdominal bulging (or “pooching”), and even abdominal hernia.

DIEP flap breast reconstruction is similar to TRAM flap surgery but spares the rectus abdominus muscle. SKIN AND FAT ONLY are removed from the abdomen, transplanted to the chest and connected using microsurgery to create the new breast. NO MUSCLE is sacrificed. As the sit-up muscle is left behind in its natural place many of the above complications are avoided and the patient essentially receives a tummy tuck at the same time as the breast reconstruction. There also tends to be far less pain following the DIEP procedure, and a quicker recovery time.

Knowing the significant advantages of the DIEP flap it is easy to understand the reason for all the hype, especially for active individuals who don’t want to sacrifice the strength of their abdomen. A breast that has been reconstructed with fat and skin will also look and feel more natural than an implant reconstruction and will last longer. Unlike an implant, the reconstructed breast also ages like a natural breast.

As with all types of breast reconstruction however, 2 or 3 procedures performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result. Unfortunately, due to the complexity of the DIEP procedure very few centers in the US perform DIEP flap surgery so many patients will have to travel for the procedure. The good news is that many of these DIEP flap centers will accommodate out-of-state and even international patients.

To learn if a breast center or plastic surgeon near you offers DIEP flap breast reconstruction, please check the following websites:
www.breastrecon.com and www.diepsisters.com

The lists on these websites seem fairly thorough but there are plastic surgeons out there who perform DIEP breast reconstruction that have not made the lists (for whatever reason). Having said that, currently there are only about 40 plastic surgeons in the US that routinely perform the DIEP flap procedure. Before choosing a plastic surgeon ensure that he/she is certified by the American Board of Plastic Surgery and has extensive experience with the DIEP flap procedure. Ask about the success rate of the procedure in their hands (most DIEP flap specialists boast a flap survival rate of at least 97%) and how many DIEP flaps they have performed.

Insurance companies are federally mandated to pay for the cost of breast reconstruction. Unfortunately, some patients will still face difficulties in gaining access to a DIEP flap surgeon and the procedure. Here again it pays to seek out plastic surgeons who specialize in the DIEP procedure as typically insurance specialists are available to help patients with insurance issues.

Learn more about the DIEP flap procedure and other breast reconstruction options here.


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Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

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