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Interior Cancer Journal

Muscle-Sparing DIEP Flap Combines Breast Reconstruction with a Tummy Tuck

With advances in microsurgery over the last decade, new reconstructive procedures are available to women following mastectomy, including the deep inferior epigastric perforator (DIEP) flap, which is performed by only about 10 percent of plastic and reconstructive surgeons in Houston. For the convenience of women who live in West Houston, the DIEP flap and other microsurgical breast reconstruction procedures are available at Memorial Hermann Katy Hospital and Memorial Hermann Cancer Center- Memorial City.

“Microsurgical procedures can provide women with a very natural looking breast reconstruction using abdominal tissue,” says Rafi Bidros, M.D., FACS, a plastic and reconstructive surgeon affiliated with Memorial Hermann Memorial City Medical Center and Memorial Hermann Katy Hospital.

“Because they do not use abdominal muscle, they tend to result in fewer donor site complications. But microsurgical reconstruction is more complex, with a higher risk of complication, and should be performed only by plastic surgeons who perform microsurgery regularly in institutions with experience in monitoring the flaps postoperatively.”

“I’m not biased toward one surgery or the other. I meet with patients and review the pros and cons to find the best match for each woman. The most important thing is to do it right the first time. I believe that women have the right to feel whole again after breast cancer.”

- Rafi Bidros, M.D., FACS

Dr. Bidros is among a handful of plastic surgeons practicing outside the Texas Medical Center with expertise in performing DIEP flap reconstruction.

“My goal is to perform autologous reconstruction so that women who have their own natural breast on one side can obtain natural tissue for the other breast, which helps achieve better symmetry,” he says. “Because skin and fat are removed from the belly, having a DIEP flap means your belly will be flatter and tighter as with a tummy tuck. In most cases the scar is below the bikini line.

No mesh material is required to support the abdominal wall, as may be the case with a TRAM flap.”
The pedicled transverse rectus abdominis myocutaneous (TRAM) flap had been the most common method of tissue reconstruction after mastectomy.

With a TRAM flap, abdominal muscles, tissue, skin and fat are used to create a natural breast shape. Unlike the TRAM flap, the DIEP flap does not remove muscle tissue unnecessarily, which Dr. Bidros believes results in a faster recovery.

As a student at Louisiana State University School of Medicine, Dr. Bidros trained with Robert J. Allen, M.D., who pioneered microsurgical breast reconstruction including the DIEP, SGAP, IGAP and SIEA* perforator flaps. “Dr. Allen was the first to note that reconstructive breast surgery can be performed without using muscle,” Dr. Bidros says. “DIEP is more technically challenging than TRAM but it produces the same outcome and allows women to keep their abdominal muscle. This offers an advantage to women who might be considering a tummy tuck to improve the aesthetics of the abdomen.

It’s a bigger surgery but it will last a lifetime, unlike an implant, which usually requires more maintenance.” Dr. Bidros continued his training in DIEP flap breast reconstruction with several renowned DIEP specialists including Belgian surgeon Phillip N. Blondeel, M.D., Ph.D., FCCP, an internationally known expert on aesthetic and reconstructive breast surgery and a pioneer of perforator flap surgery.

Dr. Bidros offers his patients the full range of options for reconstruction, including shaped implants, DIEP and other perforator flaps, fat grafting and hybrid techniques, as well as partial breast reconstruction for lumpectomy patients. “I’m not biased toward one surgery or the other,” he says. “I meet with patients and review the pros and cons to find the best match for each woman. The most important thing is to do it right the first time. I believe that women have the right to feel whole again after breast cancer.”

He also encourages prospective breast reconstruction patients to preplan with the breast surgeon for a better outcome.
“With a team approach, the success rate is very high,” he says. “Ultimately, the final choice of flap depends on the patient’s anatomy and the quality of the tissue harvested. Different surgeons produce different results. The refinements we offer in breast surgery are based on aesthetics. Part of that is the innate ability of the surgeon, and part of it comes with experience.”

*Superior gluteal artery perforator (SGAP), inferior gluteal artery perforator (IGAP), and superficial inferior epigastric artery (SIEA) flaps