What are the major benefits of the DIEP and SIEA procedures over other breast reconstruction procedures?
Unlike the traditional TRAM flap, the DIEP procedure spares the rectus abdominis muscle (or the "abs"), because it is based on small vessels that are microscopically separated from the muscle, leaving it intact. The rectus muscle acts as a counterbalance for the spinal muscles, and is important in straight posture as well as sitting activities. The SIEA procedure entails an even more superficial surgical dissection, where the deeper muscle layers are left undisturbed.
Who is a candidate for these procedures?
The DIEP or the SIEA procedures can be performed in all patients who have an adequate amount of abdominal tissue, provided that their medical status is not a contraindication. These procedures are best performed on patients who are active enough to appreciate the preservation of abdominal muscles. Older patients who are in poor health are not candidates, mainly due to the longer duration of the procedure, and are best served by a simpler form of reconstruction.
What determines which procedure is performed and when is this determination made?
During the initial patient consultation, all available procedures are discussed. Once the patient is found to be a good candidate for breast reconstruction with their own excess abdominal tissue, the SIEA or the DIEP flaps are preferred. Depending on the anatomy, the decision as to which flap is performed is made intraoperatively. The recovery and long-term results are similar for both flaps.
Do insurance companies cover breast reconstruction?
Yes, insurance companies are required by law to cover breast reconstruction procedures after complete or partial mastectomy. This includes breast reconstruction at any time after mastectomy, as well as any surgery on the other breast, if required for symmetry. Please click here for more information.
Can these procedures be done immediately following mastectomy? Can they be done following radiation?
Both the DIEP and the SIEA flaps can be performed immediately after mastectomy or at a later date after radiation treatment is completed.
Will the reconstructed breast be made symmetrical to the existing breast?
Yes, the symmetry procedure is performed approximately three to four months after the initial flap. The second stage provides refinement of the shape of the reconstructed breast as well as lifting or reduction of the other breast to achieve optimal balance.
What is done for restoring the nipple and areola?
The final stage of breast restoration takes place about two to three months after the second stage procedure. Initially the nipple is reconstructed using the flap tissue, and then medical tattooing is performed to restore the color of the areola. Both of these are performed as minor office procedures.
Will the reconstructed breast have sensation?
The final goal of beast restoration is not only to create a soft, symmetric breast but also to restore sensation. This can be achieved by microsurgically connecting the sensory nerve of the breast that is severed during the mastectomy to the sensate nerve of the abdominal tissue. Over a period of three to six months, the nerve grows slowly and offers the possibility of regaining normal sensation.
How are the long-term results?
The short and long-term results are excellent. Patients are able to leave the hospital after four to five days. They are able to ambulate on post-operative day number three. Patients return to normal daily activities after about 2 weeks, and are able to resume exercise and lifting after 6 weeks.