What Does Flap Breast Reconstruction Involve?

If you're considering breast reconstruction using your own tissue (a "flap" procedure), it's important to know that achieving the best results usually involves several stages and takes time.

BEFORE skin-sparing mastectomies and DIEP flaps

AFTER skin-sparing mastectomies and DIEP flaps

The patient in the pictures above required the following stages to complete her breast reconstruction:

Stage 1: The Initial Breast Reconstruction

Whenever possible, breast reconstruction should be performed at the same time as the mastectomy. This is known as "immediate breast reconstruction". This allows for less scarring because the natural breast skin envelope can usually be preserved ("skin sparing mastectomy"). Only the nipple, areola and breast tissue under the skin is removed. The patient above had bilateral skin-sparing mastectomies and DIEP flap reconstruction using tissue from her lower abdomen.

In some cases, the nipple and areola can also be preserved. This is called a nipple-sparing mastectomy.

Immediate reconstruction enables the patient to wake up from the surgery "complete" and avoid the experience of a flat chest altogether. Most women with early breast cancer (stage I or II) are candidates for this approach.

If immediate reconstruction isn't an option, or the patient prefers to wait, the reconstruction can be performed "delayed", any time after the mastectomy. Patients having radiation are often advised to delay reconstruction. Other reasons for delaying reconstruction include advanced breast cancer (stage III or IV) and lack of access to a specialist surgeon.

Stage 2: Revision
This is the "fine-tuning" phase and is usually performed as an outpatient procedure. This stage involves shaping the breasts and making them as symmetric as possible. Fat injections can be used to address any contour deformities and make the breasts look and feel even more natural. The donor site scar (scar from where the flap tissue was taken) is revised to make the area look as good possible. Nipple reconstruction is also usually performed at this stage if the patient did not have a nipple-sparing mastectomy.

Stage 3: Micro-pigmentation/Tattooing
This office procedure applies the "finishing touch". Color is added to the reconstructed nipple-areola complex to make the results even more natural. Women now also have the option of a 3D tattoo which can look very life-like, with or without a surgically reconstructed nipple-areola.

Each stage is performed 3 months apart which means that the entire reconstructive process can take several months. Insurance authorization is also required before each stage.

I hope this info helps.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, TX specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. He and his partners at PRMA are In-Network for most 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 others touched by breast cancer on Facebook.

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Breast Reconstruction Timing: Immediate vs Delayed Reconstruction

With so much to think about after a breast cancer diagnosis, many patients facing mastectomy do not fully understand how the timing of breast reconstruction influences how the reconstructed breasts will ultimately look.

Breast reconstruction can be performed at the same time as the mastectomy ("immediate reconstruction") or a while after mastectomy ("delayed reconstruction").

When the mastectomy and reconstruction are performed at the same time, a skin-sparing mastectomy can usually be performed which saves the majority of the natural breast skin envelope (except for the nipple and areola). Only the actual breast tissue under the skin is removed. The reconstruction then "fills" this empty skin envelope. In some select cases the nipple and areola can also be saved. This is known as a nipple-sparing mastectomy.

Skin-sparing (or nipple-sparing) mastectomy and immediate breast reconstruction produce the most "natural" results with the least scarring. Skin-sparing mastectomy and immediate reconstruction is therefore preferred whenever possible and should be the goal for breast cancer patients with early disease (stage I or II).

Delayed reconstruction unfortunately leaves more scarring (typically) and the final breast is less likely to look like the breasts Mother Nature provided. Common reasons to delay reconstruction include advanced breast cancer (stage III or IV), inflammatory breast cancer, the plan for radiation therapy after mastectomy, and lack of access to a reconstructive surgeon.

The difference in scarring between immediate and delayed breast reconstruction can be seen in these breast reconstruction before and after photos.

Ultimately the priority must always be "life before breast" - obviously the breast cancer treatment comes first in terms of priority. However, all other things being equal, there will sometimes be a choice to be made between having the reconstruction performed with the mastectomy or some time after the mastectomy. Whenever possible, I encourage women to seek immediate reconstruction for the best cosmetic results.

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Dr Chrysopoulo is a board certified plastic surgeon specializing in the latest breast reconstruction techniques including the DIEP flap procedure. He and his partners perform over 500 DIEP flap procedures per year and are In-Network for most US insurance plans. Learn more about your breast reconstruction options and connect with other breast reconstruction patients here. You can also follow Dr C on Twitter!

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