Its kind of funny really. We spend so much of our time telling people to lose weight, be fit, look after themselves. Then, a diagnosis of breast cancer comes up. That isn’t fair. So you hear the words mastectomy, and you have the discussion about reconstruction options. Alas, you don’t weigh enough, you’re too thin and so your only option is to have an implant based reconstruction. Right?
Well, not quite.
There are typically two reasons that we might suggest that a woman isn’t a great candidate for a DIEP: 1) the volume of her breast compared to the volume of tissue that can be harvested from the abdomen is insufficient, and 2) if a DIEP flap is taken from the abdomen, there isn’t enough “excess” to allow the abdomen to then close.
So, how can we extend the options of thinner women to include DIEP flap breast reconstruction? What are the choices for a woman with a size 8 waist and D cup breasts?
To work around these problems, we have to consider how we might be able to increase the volume of tissue that can be raised from the abdomen to use in a breast reconstruction. In most cases, when a DIEP flap is performed, tissue is raised mostly from one side of the abdomen, based on the blood vessels just from that side of the abdomen. We can however increase the volume of tissue available by raising tissue from both sides of the abdomen. The difficulty with this is that the blood vessels from one side of the abdomen are insufficient to provide adequate blood flow to the tissue from both sides. The way around this problem is to raise the abdominal tissue with blood vessels from both sides. This then requires that the blood vessels on each side of the abdomen are connected microsugically to blood vessels in the chest. This is typically referred to as “stacking” the two DIEP flaps; obviously, this is a good deal more complicated than a normal DIEP, but it does allow us to maximise the amount of tissue that can be recruited to reconstruct the breast.
“Stacking” flaps is a brilliant technique. It opens up a new avenue for breast reconstruction to thinner patients. There are still limitations, but for women who want to consider using their own tissue (and the abdominal tissue remains the best choice) for breast reconstruction, and maintain their breast size, then here is an answer.
There can be some trade-offs for the thinner ladies though: most especially with scar placement on the abdomen. In the absence of skin excess, the scar must sometimes be placed higher to allow for the closure of the donor site. This is a fairly subjective concern – some women will worry about this, many others won’t.
For what it’s worth though, thinner patients will typically have lower incidence of fat necrosis, seroma, infection and donor site wound breakdown. So the pros most certainly can outweigh the cons.
As always, its a personal choice, so talk to your Plastic Surgeon about whether (even if you’re a thin lady) DIEP flap breast reconstruction is a possibility for you.