It has been shown that patient satisfaction is superior in autologous breast reconstruction (using the patients own tissue) when compared to implant based reconstruction. While these microsurgery cases are long and technically demanding, we believe that the benefits of autologous tissue breast reconstruction while preserving abdominal wall integrity makes it well worth our time and effort.

Dr. Theresa Wang and Dr. Samuel Shih are amongst only a handful of surgeons in Georgia that routinely utilize the DIEP and SIEA flaps in breast reconstruction. These techniques utilize the patients’ own abdominal skin and fat to recreate the breasts while sparing the abdominal muscles.

DIEP Flap Reconstruction

The DIEP flap is the latest modification of the traditional pedicled TRAM procedure. The TRAM was pioneered by Dr. Carl Hartrampf in 1981 and actually originated in Atlanta, Georgia. Since then, there have been several modifications such as free TRAM and muscle sparing TRAM. These modifications have resulted in a flap with a more robust blood supply and less abdominal wall morbidity.

The DIEP flap is a free flap where the abdominal muscles are preserved. Only the skin and fat are utilized in DIEP flap breast reconstruction thus causing even less abdominal wall morbidity.

The skin and fat are removed from the abdomen via a tummy tuck incision while keeping the blood supply attached via the Deep Inferior Epigastric (DIEP) Vessels. The skin/fat flap is then transplanted to the chest where it is connected to blood vessels using a microscope. The skin and fat are then molded into the shape of a breast.

Stacked DIEP Flap Reconstruction

The Stacked DIEP Flap is where both sides of the abdomen (two DIEP flaps) are used to reconstruct one breast. It is an option for unilateral breast reconstruction in women who do not have sufficient fatty tissue for a single DIEP flap breast reconstruction.

This technique provides the opportunity for women who usually are not candidates for abdominally-based breast reconstruction to receive DIEP flap reconstruction.

Dr. Theresa Wang and Dr. Samuel Shih are amongst the most experienced in Georgia in Stacked DIEP Flap breast reconstruction. This allows women with insufficient fatty tissue, who need reconstruction of only one breast, the option of DIEP flap reconstruction. 

SIEA Flap Reconstruction

The SIEA flap does not violate the abdominal fascia or muscle at all. It is essentially a tummy tuck, with preservation of the blood supply to the abdominal skin and fat. The blood supply, Superficial Inferior Epigastric Artery (SIEA), does not run through the abdominal musculature like the DIEP flap and therefore no violation of the abdominal fascia and muscle is needed at all.

While this would make this the ideal flap, the SIEA is frequently too small to provide robust bloody supply to the flap. Given the potential benefits, the SIEA and SIEV are dissected out and examined in every patient undergoing abdominally-based free flap reconstruction of the breasts. The SIEA flap will be offered to our patients based on our intra-operative findings.

Extension Flaps – DIEP-DCIA

There are women who require a little more fatty tissue that cannot be provided by DIEP flaps alone, in order to achieve their desired size.  These women may have the option of a DIEP flap with DCIA extension. This is where the DIEP flap is extended to another zone supplied by the Deep Circumflex Iliac Artery (DCIA). This adds an additional microvascular connection thus allowing for more blood flow to the larger flap.

Recovering from DIEP Flap Reconstruction

Due to the nature of free tissue transfers, patients are admitted post-operatively for close monitoring of the flaps. In our experience, patients recover quicker and have less pain than those receiving TRAM flap surgery and tend to ask to go home by day 3.

While we do try to offer the DIEP/SIEA flap to all our patients, there is a selection criteria that we follow that helps minimize potential complications in our patients. Please contact our office to discuss these criteria.

Other Flap Options

Abdominally based free flap breast reconstruction is dependent on the availability of skin and fat from the abdomen.  Some woman are not candidates given their prior surgical history such previous abdominoplasty “tummy tuck” or major abdominal surgery. Others, simply do not have enough fatty tissue to reconstruct the breast.

There are other donor sites that can be considered for some patients:

Thigh Flaps

• TUG FLAP – Transverse Upper Gracilis Flap – taken from the upper middle thigh
• PAP FLAP  – Profunda Artery Perforator Flap – taken from the back of the thigh “banana roll”

Buttock Flaps

• SGAP FLAP – Superior Gluteal Artery Perforator Flap – taken from the upper buttock
• IGAP FLAP – Inferior Gluteal Artery Perforator Flap – taken from the lower buttock