After a breast cancer diagnosis, women can feel inundated by the many decisions that lie ahead. What type of treatment is best? Will you have a mastectomy? And if so, what type of breast reconstruction will you choose?
All these choices are difficult, with the third often being the toughest. Patients must navigate the long-term physical and emotional factors surrounding whether, when, and how to seek breast reconstruction.
If a woman chooses breast reconstruction surgery, there are several options available, including breast implants – the most common choice worldwide. However, implants eventually wear out and must be replaced, resulting in additional surgery. This is prompting some breast cancer patients to seek out a more natural, longer-lasting option.
UT Southwestern surgeons are experts in DIEP flap (pronounced “deep flap"), advanced procedures that use transplanted tissue from the patient’s lower abdomen to reconstruct the breast. Some patients even regain breast sensitivity over time.
We perform approximately 300 DIEP flaps (deep inferior epigastric perforator artery flap) each year with a success rate of approximately 99%. Working closely with our oncology and cancer specialist colleagues at Harold C. Simmons Comprehensive Cancer Center, we offer a seamless experience from treatment through reconstruction.
Despite the benefits, some patients hesitate to choose DIEP flap due to concerns about the length and complexity of the procedure. Lengthy or inefficient procedures can increase a patient's recovery time and risk for complications, such as infection and swelling.
UT Southwestern’s DIEP flap approach delivers results in half the time of most breast reconstruction centers. Right now, our average operating time is just under four hours to reconstruct both breasts. That means fewer risks and getting back to your life sooner, with a shorter hospital stay and no stay in the intensive care unit.
Faster, more efficient DIEP flap approach
The intricate DIEP flap procedure requires removing blood vessels, nerves, skin, and fat from the lower abdomen. We transfer this tissue to the chest, where we restore the circulation of the breast tissue by reconnecting the blood vessels in the chest.
Through a series of microsurgical maneuvers, we replace damaged nerve tissues with healthy ones with the goal of returning sensitivity to the breast. Meanwhile, the other surgeon performs closure of the tummy resulting in flatter stomach area to accommodate for the removal of abdominal tissue. We strive to conceal surgical scars to achieve a natural appearance.
How we improved the process: For the past year, we analyzed each step in the intensive DIEP flap procedure. We laid out a process map and walked through it step by step to close gaps in efficiency.
For example, we noticed there were certain times when one of us was waiting for the other to complete a step, often due to the standard surgical setup. So, we rearranged a bit and introduced new equipment.
One small tool has made a huge difference: glasses that include a magnification function. Now we don't have to bring a large microscope into the OR, saving space so we can work side by side.
Improved efficiency translates directly into patient benefits – from less time under anesthesia to less tissue exposure, which lowers the risk of infection, swelling, and post-surgical pain.
We continue to increase efficiency with every procedure without sacrificing quality. Currently, the shortest procedure we've completed was just less than two hours.
Related reading: Frequently asked questions about breast reconstruction options
More restful recovery
After surgery, patients must refrain from physical activity for four to six weeks to allow the donor site to fully heal. Walking is allowed and encouraged. Recovery is based more on the healing of the donor site than the breast itself.
That part hasn't changed. However, we have made some major changes to how and where the patient's recovery begins.
How we improved the process: Most centers – including ours, until recently – require patients to recover in the intensive care unit after DIEP flap. This is because specialized nurses must frequently check the blood flow to the patient's new breast. In rare cases where the blood flow is not sufficient, the flap will "fail," meaning the tissue dies and the patient will require additional surgery.
When the COVID-19 pandemic put a premium on ICU beds, we moved our patients into a quieter, less bustling recovery area where they would have the same access to our expert nurses with a more restful experience. And since the surgery is shorter, patients typically stay an average of three days or less in the hospital – about half of the average stay at most centers.
Transforming Breast Reconstruction
After battling breast cancer, Wendy Razook turned to the UT Southwestern plastic surgery team of Dr. Sumeet Teotia and Dr. Nicholas Haddock for an innovative approach to breast reconstruction that delivered a shorter surgery and recovery time and natural results.
Expanded candidacy for flap reconstruction
Most patients who are candidates for breast reconstruction can consider DIEP flap surgery. We can do the procedure immediately after a mastectomy or later if the patient prefers to wait.
However, we see a fair number of patients who've been told they can't have DIEP flap for anatomical reasons, such as past abdominal surgeries.
UT Southwestern is a leader in alternative free-flap procedures, performing hundreds of these complex procedures each year. If moving tissue from your abdomen isn't an option, we can discuss one of these approaches:
● PAP (profunda artery perforator) flap: Donor tissue comes from the back of the inner thigh, below the buttock. UT Southwestern is an international leader for this variation. We perform approximately 300 PAP flaps a year, and surgeons around the world regularly consult with our team to learn the technique.
● LAP (lumbar artery perforator) flap: We transfer tissue from the lower back and/or upper buttock.
● Quadruple 4-flap: This variation is a rare combination of multiple free flaps. Donor tissue is usually taken from the lower abdomen and the thigh, or sometimes the lower back.
● Stacked flaps: Generally, tissues are moved from more than one place (similar to 4-flap surgery).
Your safety and happiness are our priority
After going through the trials and tribulations of breast cancer treatment, you deserve to have the smoothest breast reconstruction experience and recovery possible. With any option you choose, our top priorities are your safety and your happiness with the results.
With more DIEP flap options than ever before – and maximized efficiencies – you can get the natural results you want that will last the rest of your life.
Breast reconstruction is a personal choice. We will partner with you to personalize your breast reconstruction procedure based on your body, needs, and goals – our role is to help you achieve balance in your life again.