A history of abdominal surgery doesn’t necessarily mean you’re unable to have DIEP flap breast reconstruction. This decision is determined on a case-by-case basis that depends on your personal surgical history and its effects on your abdominal area.
Abdominal surgeries are very common, and many women have one or more throughout their lifetime. Luckily, these procedures typically don’t keep someone from having DIEP because they don’t significantly damage the donor site area.
Procedures that don’t normally affect DIEP include:
- Caesarian sections
- Tubal ligation
- Gallbladder surgery
- Laparoscopic surgeries
- Other procedures that leave Pfannenstiel (“bikini line”) scars
Surgeons look at specific factors when deciding if a patient is a candidate for DIEP breast reconstruction. The depth and position of a scar—as well as the intactness of essential blood vessels—can help determine whether or not someone can have DIEP surgery.
After surgery, collagen proteins repair the injury and create scar tissue. This newly formed tissue is thicker and stiffer than before and behaves differently from normal, undamaged tissue.
An external scar that forms at the surface of the skin doesn’t usually cause any problems for DIEP surgery. Internal scarring that extends farther below the skin can cause issues. Because the deeper skin and fat are damaged, they can no longer be used to rebuild the breasts.
For DIEP breast reconstruction, blood vessels from the abdominal area are taken and connected to blood vessels in the chest to supply the new breasts. Certain abdominal surgeries can damage these blood vessels, making them unusable for DIEP flaps.
Magnetic Resonance Angiography (MRA) is done before DIEP reconstruction to locate the exact arrangement and position of the perforator vessels at the abdominal donor site. This imaging can also ensure these vessels are unobstructed and undamaged from previous surgery.
Certain abdominal surgeries can make it impossible to have DIEP breast reconstruction. Procedures like abdominoplasties (tummy tucks) and liposuction can cause extensive damage to the anatomy at the donor site area.
Abdominoplasties remove the essential blood vessels needed for DIEP reconstruction, and liposuction causes the internal scarring we mentioned before. Both of these procedures also remove the excess abdominal tissue needed for DIEP surgery.
TRAM breast reconstruction uses skin, fat, and muscle from the abdomen. As a result, it weakens the abdominal muscles and doesn’t leave enough extra tissue to form the DIEP flaps. Extensive abdominal wall reconstruction and complex hernia repairs can also disturb the integrity of the abdominal wall and damage the blood vessels required for DIEP.
If a patient isn’t a candidate for DIEP surgery, they may still be able to have natural breast reconstruction. Our surgeons at the Center for Natural Breast Reconstruction can use alternative donor sites to rebuild the breasts after mastectomy.
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