It can be hard to know to which breast reconstruction technique is best for you. At Bajaj Plastic Surgery, we understand that post-mastectomy breast reconstruction can be an emotionally difficult and very intimate experience. We strive to educate, guide, support our patients through the entire reconstruction process and offer options including DIEP Flap Breast Reconstruction.
Why Choose Dr. Bajaj?
Dr. Bajaj and her father, Dr. P.S. Bajaj, began performing DIEP flap breast reconstruction and other microvascular flaps for breast reconstruction in Oklahoma City in 2007. Since then, they have performed over 500 such procedures with low complication rates and excellent outcomes (our flap success rate is over 98%). Many publications have emphasized that with these technically challenging procedures, the more you do, the better your outcomes. Dr. Bajaj has performed over 500 DIEP flaps; currently, she performs over 45-50 DIEP flap breast reconstruction cases (or 60-80 flaps) annually, which places her and St. Anthony Hospital at the level of a high-volume center with excellent outcomes. She is recognized as a national leader in this area and has spoken extensively about her experience performing DIEP flaps in a private practice setting and establishing a program from its inception.
What is the DIEP Flap?
The DIEP (Deep Inferior Epigastric Perforator) Flap is a type of breast reconstruction procedure that removes tissue from the abdomen to rebuild natural breasts without the need for synthetic implants. The DIEP Flap procedure utilizes fat, tissue, and blood vessels from the lower abdomen. An advantage of this particular reconstruction technique is that the rectus abdominis muscle is preserved, which helps to preserve abdominal strength, decreases the risk of hernias and bulges, and results in a faster recovery time.
The Science Behind the DIEP Flap Procedure
In a DIEP flap, breasts are reconstructed using fat, skin, and blood vessels from the lower abdomen – the skin and fat between the belly button and pubic bone that can be pinched. Using microsurgerical techniques, the blood vessels obtained from the lower belly are then connected to the blood vessels in the chest under a microscope. The use of living tissues instead of implants allows for a natural look and feel which will last an entire lifetime.
Why Consider This Procedure?
The DIEP flap procedure is a highly effective and long-lasting option. However, patients need to carefully consider which surgeon and clinic to perform this operation, as it requires highly specialized training, equipment, and extensive experience. Furthermore, reconstruction using your own tissue may be a better option if you have had previous radiation therapy as part of your cancer treatment since implant-based breast reconstruction can have a high complication.
Most women pursue breast reconstruction surgery for physical, mental, and emotional reasons. These patients are not only looking to restore their breasts’ natural contours but also to enjoy the numerous benefits that the DIEP Flap procedure provides. These include:
- Physical symmetry
- Restored confidence
- Improved quality of life
- Reduced anxiety
- Minimizes loss of muscle function
- Minimizes risk of abdominal hernia
- Less postoperative pain
- Quicker recovery
- Flatter abdomen
- Natural appearance
Good candidates for the DIEP flap are women who are in good health, don’t smoke, and are not morbidly obese. Women who desire this procedure typically have previously undergone a mastectomy and are looking to restore their natural breast contour. You will also need to have sufficient amounts of abdominal tissue that can be removed and added to the breasts. If you do not have enough tissue in your lower abdomen, Dr. Bajaj will discuss other options with you. Other options may include taking tissue from the back, buttocks, or inner thighs. If deemed a suitable candidate, Dr. Bajaj will work with each patient to create a custom treatment plan to meet their exact breast reconstruction needs.
As with many surgeries, it is necessary to stop smoking for at least six weeks before the breast reconstruction procedure. Anti-inflammatory medications should be avoided for two weeks before the procedure, as these thin the blood which can pose a risk during surgery.
The DIEP Flap Procedure
The DIEP flap procedure is performed under general anesthesia at St. Anthony Hospital. Before beginning the procedure, Dr. Bajaj will make all the necessary markings on your abdomen and the breasts. Dr. Bajaj will begin the procedure by making an incision in the abdomen, near the public line. She will then carefully remove the excess tissue. The DIEP flap allows for preservation of the abdominal muscles since the skin and fat is taken with its blood supply. These blood vessels are dissected through the muscle to their origin in the groin; occasionally, a small amount of muscle must be taken to protect the blood vessels. The excess tissue, fat, and blood vessels will all be transferred to the breast to create a natural breast mound. Dr. Bajaj will perform microsurgery to join the blood vessels in the tissue sample with the blood vessels in the chest. Since no muscle or very little is taken, DIEP flap breast reconstruction surgery offers a quicker recovery and less pain compared with to other types of breast reconstructive surgery, including implants and tissue expanders. Likewise, since most if not all the muscle is preserved, there is a lower risk of losing abdominal strength or developing abdominal bulges or hernias. The surgery typically takes between 6-8 hours to perform reconstruction on both breasts. The operating room team and nursing staff at St. Anthony Hospital have been assisting Dr. Bajaj since 2007 and understand the complexity of this procedure; and by working as a team, they are able to be efficient while providing quality care for you.
Once the procedure is complete, Dr. Bajaj will place you in a surgical bra to support the breasts. Since incorporating ERAS (Enhanced Recovery After Surgery) protocols, Dr. Bajaj has observed that her patients have a smoother, more comfortable recovery. Patients will be in the hospital for 2-3 days – the blood flow to the flap will be monitored closely for the first 24 hours. After that, you will be able to begin walking and eating regular food. Dr. Bajaj believes in a multi-modal approach to pain management. Patients will receive pain control via local anesthesia (Exparel), anti-inflammatories, and narcotics. You will have drains which may be removed prior to going home. Most patients will be able to drive between 10-14 days after surgery; and most find that they need 4-6 weeks off work. Maintaining a healthy diet and walking after surgery are critical to your recover. Particularly strenuous activities can be resumed after 6-8 weeks unless otherwise stated by Dr. Bajaj.
Schedule A Consultation
Dr. Bajaj wants every patient to have the utmost confidence in the procedure they’re going to undergo. For breast reconstruction, she recognizes the sensitive nature of this procedure, helping each one of her patients feel at ease in her care. During the initial consultation with Dr. Bajaj, she will perform a comprehensive evaluation of you, considering your medical history, goals for the surgery, any medications, previous surgeries, and current health conditions, if any, to determine if you are a good candidate for surgery. If you are a suitable candidate for surgery, Dr. Bajaj will work with the you to build a treatment plan based on your needs and review all aspects of the DIEP flap procedure.
Many variables go into calculating the total cost of a DIEP flap procedure, the extent of breast reconstruction needed and the patient’s particular case. It is worth noting that a federal law passed in 1998 requires all group health plans to assist with covering the cost of mastectomies and any resulting reconstructive surgeries. This was set in place by the Women’s Health and Cancer Rights Act. These benefits can help defray the overall cost, but it is important that patients check with their insurance company to determine exactly how much of the cost will be covered. Patients can speak with Dr. Bajaj during an initial consultation and build a treatment plan tailored to their needs. Our insurance coordinator at Bajaj Plastic Surgery is also happy to assist you with questions regarding insurance coverage and authorization. Please contact our Oklahoma City office today and schedule a consultation.