This week, Richard M. Kline, Jr., MD and James Craigie, MD of The Center for Natural Breast Reconstruction answers your question.Question: I had left implant removed due to contracture. ( double mastectomy and left radiation) Just had DIEP surgery that failed so now have no left breast. I am thin , especially now with little belly removed. What are my options for reconstruction now? Answer: I’m sorry you are having such difficulty getting a satisfactory reconstruction. As you know, given your history of radiation and prior problems, you are unlikely to ever get a successful reconstruction of the left breast with an implant.When the DIEP is not available, the next option is often the sGAP flap (from the buttocks). This is far less widely available than the DIEP flap, but we have performed about 300, with a 95.7% success rate (our DIEP success rate is a little higher, at 99.08%). Other options include the PAP flap, from the posterior upper thigh, the anterolateral thigh flap, and the latissimus flap. The latissimus is rarely large enough to use by itself, and is usually combined with an implant; unfortunately, in a radiated tissue bed, the implant still often does not work well, even with a latissimus covering it.Sometimes we can do two smaller flaps at the same time to reconstruct one breast. This is more difficult with a previous flap failure, as the recipient vessels are a little harder to reach, but we have done it successfully in some cases.Over the last few years we have gained extensive experience augmenting the size of natural tissue flaps with fat grafting. This basically means we first do a natural tissue flap, then come back a few months later and do liposuction (yes, it can be a problem getting fat in some people), then inject the fat with specially designed needles into the flap. On some occasions, we have essentially doubled the size of flaps, although our ability to do this obviously varies with different patients’ body types. We have successfully made small “C” breast mounds even with latissimus alone + fat grafting, however.I would be happy to chat with you by phone, or see you in person and discuss your options further, if you wish.Thanks for your question!Answer #2: I'm sorry to hear you have had a difficult time. I'm sure you still have options. If I had additional information about the size of your natural breast and your body weight I could perhaps be more specific. In our practice we use your own fatty tissue without muscle sacrifice. If the DIEP did not work out then possibly thigh, or buttock fat or a combination of the two would be an option.Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!