The Deep Inferior Epigastric Perforator (DIEP) flap is the procedure of choice for breast reconstruction using the patient’s own tissue. Despite its versatility and excellent cosmetic results, the DIEP flap may not be ideal in patients with history of abdominoplasty (tummy tuck) or abdominal hernia repair. Also very thin patients may not qualify. For these patients alternative flaps must be considered. One of the more attractive techniques is the Profunda Artery Perforator (PAP) flap, which uses the fat located in the back on the thigh. This technique provides exceptional amounts of fat for breast reconstruction, even in the extremely thin, for an excellent breast shape. The scar is very easily hidden and barely noticeable. Additionally, patients undergoing this procedure end with thinner thighs, often considered a very attractive feature.
This procedure can be performed either immediately after a mastectomy or in a delayed fashion. This is also an excellent technique for patients who had undergone procedures at other institutions with poor or non-satisfactory results, such as patients with prior radiation or multiple implant failures. Additionally, with the PAP flap no leg muscle is removed, hence the patient will only experience a minor discomfort and can return to a normal routine within three to four weeks, resuming light activities in two weeks and full activities in three to four weeks. Like the DIEP flap, the average length of hospital stay for the PAP flap is two days.
Only a history and physical exam is necessary to determine if you are a candidate for the PAP flap for breast reconstruction. Please feel free to call the office in order to schedule an appointment for evaluation of PAP flap breast reconstruction.
What is the DIEP flap procedure?
The Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction is the most common technique used in breast reconstruction with the patient’s own tissue at HPCS. This technique utilizes the lower abdominal skin and fat to reconstruct the breast. The major benefit is that most patients who come for breast reconstruction will have extra tissue in the abdomen that can be used for breast reconstruction. The patients get in essence a “tummy tuck” and that tummy tuck tissue instead of being thrown away is used for breast reconstruction. The patients are left with a tighter and flatter abdomen in addition to natural feeling autologous breast reconstruction. This breast reconstruction tends to be soft and supple though somewhat fuller, higher and “perkier” that a natural breast. The breast reconstruction moves none of the muscle and therefore the patients are left with almost no complications, such as abdominal hernias.
Integrity in DIEP flap surgery is paramount. As the popularity of the DIEP flap has become more widespread, an unfortunate side note is surgeons stating that they perform a DIEP flap when in reality, they are performing a Transverse Rectus Abdominis Muscle (TRAM) flap. In the TRAM procedure, muscle is removed from the abdomen and the patient is left with a weak spot in the abdominal musculature, resulting in a propensity for bulging and pain. At HPCS, all patients have access to a photograph of the flap showing that no muscle is taken. This is unique amongst other surgeons, as our surgeons can definitely, without a question, guarantee that no muscle will be taken in during this type of flap-based reconstruction.
Further excellence is noted in the fact that no rib is removed during this type of procedure. Many surgeons, when performing flap-based reconstruction, remove a section of the rib in order to attach the vessels that supply the blood to the flap. This, like the removal of the abdominal muscles, leaves the patient with long term pain and deformity of the chest. By avoiding this, patients are left with less pain and almost no long-term problems in the chest. Ask the surgeons more about rib removal at your consultation for DIEP flap breast reconstruction.
Why choose HPCS?
Dr. Sean Boutros, the senior surgeon at Houston Plastic & Craniofacial Surgery, has been a leader in DIEP flap breast reconstruction. He had presented at national and international meetings about DIEP flap breast reconstruction for many years. He has published numerous papers about the DIEP flap breast reconstruction in both national and international journals. His lead article in the March 2014 plastic and reconstructive surgery is the largest series ever published in DIEP flap. Dr. Boutros has personally performed over 1300 DIEP flaps giving him one of the highest success rates ever reported amongst any surgeon.
DIEP Flap Breast Reconstruction Recovery
The average length of stay following Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction is two days, due to the fact that no rib or abdominal muscles are taken during the procedure. Moreover, some patients require little or no narcotics to treat their postoperative pain. This much shorter length of possible stay is significantly advantageous for the patients, decreasing the risk of hospital-acquired infections or other issues associated with prolonged hospital stays.
Following the vast experience collected over the past few years, our meticulous techniques permit surgeries with minimal blood losses, thus obviating the need for blood transfusions. In patients who have not undergone chemotherapy, there have been no blood transfusions in over seven years. The patients who have had chemotherapy still maintain a less than 1% transfusion rate with transfusions only necessary in patients with low blood level secondary to chemotherapy. This avoids an entire set of problem that can come with blood transfusion, including immunosuppression, transfusion reactions, and rare contamination with HIV or hepatitis C.