Choosing what manner of reconstruction to undergo after mastectomy, DIEP flap or implant breast reconstruction, is a personal and sometimes difficult choice. Sometimes, your doctor will shepherd you towards one selection and sometimes you will be good candidate for multiple choices.
Natural tissue reconstruction like the DIEP flap requires an additional incision at the donor site and usually requires a three night stay in the hospital. The breast is reconstructed with tissue very similar to that which was removed with the mastectomy surgery so they tend to look and feel the most natural. When there is a paucity of breast skin or flexibility of the skin, such as after radiation or when skin must me removed to get rid of the cancer, natural tissue reconstructions can bring in not only shape and volume but also as much skin as is needed. DIEP flap reconstruction typically requires zero or one small revision surgery for a very nice aesthetic outcome.
Implant surgery requires no incisions outside of the breast, takes less time to complete (at least for the first stage) and usually requires a 1 to 2 night stay in the hospital. Implant reconstruction, however, typically requires multiple postoperative clinic visits for expansion followed by a second surgery, an outpatient procedure, for removal of the tissue expander and placement of the final device.
In a small subset of patients, a woman can go straight to her final implant at the first surgery (see my post on radiation and tissue expanders). Implant-based reconstruction has as its greatest risks infection of the device or scar formation that generates a capsule around the device. This capsule can contract over time, causing hardening, shape change, and malposition of the implant. When this contracture is severe or associated with discomfort, this is treated with additional surgery. With natural tissue reconstruction, these changes are unlikely.
If a patient is soon to require radiation, capsular contracture (contraction of the scar capsule around the implant) is more likely and more severe. Planned implant reconstructions can be changed to natural tissue reconstruction when it is determined late in the woman’s course of treatment that she will need radiation.
Smokers are encouraged to stop smoking with any surgery but are discouraged from free tissue reconstruction because of complications in the blood vessel connection that smoking can cause. This risk is reversible with cessation of smoking one month before surgery.
At the end of their consultation visit, most women will know which reconstructive options they elect. Others may need to reflect upon this choice with loved ones outside of the clinic. We are happy to answer any additional or late questions as they arise to help a woman through this decision process.
Choosing Between Diep Flap and Implant Breast Reconstruction – Christine Fisher MD
Written by Christine Fisher MD. All rights reserved.
Christine Fisher MD
