Stacked DIEP Flap

Is Stacked DIEP Flap Surgery for you?

Many patients who want breast reconstruction, but have minimal abdominal donor sites available for reconstruction are great candidates for a Stacked DIEP Flap procedure. These patients often require autologous tissue due to a variety of reasons including prior radiation history, failure of implant based reconstruction or desire to avoid implants based on these techniques. For these patients, the stack flap is an excellent option. The stack flap uses two separate flaps for a single breast reconstruction. This can be done in a variety of different ways. This can be done with an inner thigh (PAP flap combined with abdominal flap) DIEP flap. This is the most common method of stack flap and allows for an excellent volume of reconstruction even in thin patients. Combining these two flaps will give excellent breast volume, and will allow for a smaller PAP flap thereby providing for a more inconspicuous scar. The shape attained with this flap is superior to either abdominal flap or PAP flap alone; as it gives excellent inferior pole projection with a tapered superior pole resulting in a very natural appearance. The recovery for stack flap is similar to that for a DIEP flap alone as the principles of avoiding rib and rib removal and muscle removal remain intact.

Patients often choose this flap for reconstruction and it provides excellent results.

Some patients may have already undergone abdominoplasties and still require a stack flap. For these patients, we will often use a tack/PAP flap.  In this procedure, PAP flaps from both thighs are used to reconstruct one breast. This gives an excellent reconstruction providing a significant amount of volume at the same time as an excellent overall shape.  Patients often will choose this technique if they have had a prior abdominoplasty or abdominal based breast reconstruction with a contralateral cancer occurrence.

Some patients will only require unilateral reconstruction if they do not have a significant amount of volume in the abdomen. For these patients, a DIEP stack can be performed. This allows for using both sides of the abdomen and a configuration that allows for an excellent inferior pole projection along with a slope superior pole. This technique is extremely beneficial for patients with naturally large breasts and minimal abdominal donor site and can provide excellent results with natural outcomes.

Only an adequate and thorough history and physical examination will determine the best technique for breast reconstruction for you. The experts at Houston Plastic Craniofacial & Sinus Surgery will examine you and discuss the options and alternatives for the reconstruction that is best suited to achieve your goals after mastectomy.

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.

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