Case-12968 Gallery

Before and after delayed DIEP flap breast reconstruction in a 47 year old breast cancer survivor. She previously had undergone a left mastectomy followed by chemotherapy and radiation. She unfortunately required removal of her left chest tissue expander due to infection.

She waited several years before she felt ready to try breast reconstruction again. She had an overabundance of abdominal skin and fat and therefore was a good candidate for a DIEP flap. She wanted to be reconstructed smaller than her current right breast, with a lift.

Her left breast was reconstructed using a DIEP flap. The entire lower abdominal overhang was removed during surgery. A new breast was created using some of the skin and fat, and over a kilogram (2.2 pounds) of excess fat was discarded! Her right breast was reduced and lifted at the same procedure.

Six months later, she underwent left nipple and areola reconstruction and free fat grafting to further contour her abdomen, hips, pubic region and axillary rolls (back fat/bra roll, called the “side boob” by many of our patients).

Follow up photos are shown 9 months after her reconstruction and 3 months after fat grafting. Her scars are naturally dark, given her skin tone, and will continue to fade over the next year. She has greatly improved symmetry and she now feels comfortable letting her husband see her naked. Her abdominal scar was designed as low as possible so that it hides in her undergarments and swim suit bottoms.

She has very mild lymphedema of her left arm that in fact was slightly improved with the DIEP flap surgery. She continues to wear her lymphedema sleeve for comfort and reassurance, although her lymphedema therapist advised her it is no longer necessary.

Bringing new, healthy, well-vascularized tissue up to the chest in an area of past radiation damage can often help with lymphatic drainage. If lymph nodes are encountered during the elevation of the DIEP flap, they can be included with the flap as a composite free tissue transfer.

It is difficult to find recipient lymphatic vessels if the axilla (armpit) is scarred and irradiated. However, transplanting new lymph nodes with the flap to this area can indeed breathe new life into the armpit and hopefully help with drainage of lymph fluid.