At the 2019 annual conference of the American Society of Plastic Surgeons, I interviewed Dr. Minas Chrysopoulo of PRMA in San Antonio. Dr. C points out we often talk about the results of the breast in breast reconstruction. After all, it is why the patient is having the procedure, to replace the breasts affected by breast cancer. I agree with his statement, “The conversation about the belly is well overdue.” This blog will focus on the aesthetics of the donor site in DIEP flap breast reconstruction.
As microsurgeons, skill and technique are often discussed in published papers and at medical conferences. Plastic surgery, of any kind, is about form and function. The donor site for DIEP flap, the belly, is as important to the patient. What it is going to feel and look like after surgery is essential to the physical and psychological healing for the patient. Dr. Chrysopoulo says, microsurgeons often get caught up in the technical expertise required. But, for the patient, it is what they are left with looking in the mirror for the rest of their lives that is also a valuable part of the equation of plastic surgery for breast cancer patients after surgery.
Extending the Results Beyond the Breast to the Donor Site
A DIEP flap is often compared to a tummy tuck. Should we expect the same aesthetic results from a tummy tuck after DIEP flap? Yes, and no. Here are some important points to keep in mind Dr. C points out from the video in this blog.
- DIEP flap patients can end up with a tummy scar that is higher than a tummy tuck.
- A cosmetic tummy tuck scar is very low, going down to the hairline, and curves up.
- Often times, due to a number of reasons, a patient cannot get those same results from a DIEP flap. To read more, check out the blog about the differences from PRMA.
- The belly button can be aesthetically pleasing after DIEP flap if careful consideration is given to outcomes.
- Microsurgeons cannot control where your best perforators are in the belly. These are blood vessels harvested and transferred with the flap to the breast area.
- Tissue distribution over the belly of the patient sometimes doesn’t allow for the lowest scar.
For these and other reasons scars will not be the same as a cosmetic tummy tuck. This should be part of the shared decision-making conversation with patients at the initial consult. Each patient has varying degrees of what is important for final aesthetic outcomes of the donor site in breast reconstruction. For some, the lower scar is very important. For others, they place their trust in the skill of the microsurgeon to do what is best.
Surgical Tools Used to Determine Donor Site Anatomy
When a low, hidden tummy scar is important to the patient, Dr. C explains a CT angiogram can determine where the lowest perforators are on the patient prior to surgery. It should be pointed out, there are times when the microsurgeon has to make the decision to use a perforator that may be higher. This information sharing is important during the consult, so patients know and are aware every effort will be made to optimize where the scar is placed.
Dr. C suggest three important questions to ask about the aesthetics of the donor site for DIEP flap beast reconstruction during a patient consultation.
- Where is my scar going to be?
- What are you going to do to get me the best cosmetic result?
- What should I expect?
The messaging being used by plastic surgeons in combination with patient education will improve understanding the final cosmetic results. The hope if more patients experience this in their shared decision-making conversation in breast reconstruction.
Enjoy the video to find out more about the aesthetics of the donor site in DIEP flap breast reconstruction. As Dr. says, “Words Matter!”