There is a report today on CNN.com that  Task force opposes routine mammograms for women age 40-49.  The task force states that about 15 % of the time women age 40 will detect breast cancer.  other women will experience false positives, anxiety, and unnecessary biopsies.  This task force differs in its recommendations compared to the American Cancer Society which recommends mammograms stating at age 40.  This will invariably cause problems with insurance plans, their patient's desire for mammography, and the ability of the phsician to recommend what they feel is appropriate.  My personal experience is that the youngest woman I have operated on with the diagnosis with breast cancer is 24.  Fortunately she survived and went on to have reconstruction as well.

For a number of years patients would have difficulty with contour abnormalities of the chest wall, breast reconstruction asymmetry, implant rippling in the lower poles and the most visualized medial area.  It was difficult to inform breast cancer patients about using fat grafting because of the inability to reliably tell the patient how it would work in the short and long term.  Now enough work has been done that fat grafting has firmly taken hold in the practice of plastic surgery for a number of problems.  Just as I suggested in the title of this blog, fat grafting is a major player in breast cancer reconstruction.  Even though a have performed numerous DIEP flaps and I am one of the few Plastic Surgeons who will perform two flaps on one side to provide the most volume at one time.  There are instance particularly on the later aspect of the breast where the addition of fat can be extremely helpful in reconstruction the anterior axillary fold.  I also feel that an poorly treated area by plastic surgeons is what refer to as the patient's view.  When a women looks done if there is not adequate breast volume after all of the effort to get reconstruction it is extremely frustrating.  I start the cases by harvesting the fat and then after it has been separated appropriately I begin to inject the fat.  I start with the patient supine and begin to reconstruct the lateral and inferior portions of the breast reconstruction.  Always adding volume and then comparing side-to-side.I gradually have the anesthesiologist raise the patient up  on the operating table to mimic gravity.  I will walk around and look from above to ensure that I am seeing what the patient will ultimately see.  These are just some of the ways I try to give reproducible results when I use fat graft.

The DIEP Flap is a skin and fat flap that Plastic Surgeons use to perfom total breast reconstruction after mastecomy for breast cancer using microsurgery. I like to think of the DIEP Flap as the rifinement of the procedure popularized in the 80's, the TRAM Flap. the main difference is the the DIEP Flap is a muscle and nerve preserving procedure. The results of DIEP, SIEA, TRAM, MS TRAM, are essentially all the same in terms appearance of the breast reconstruction. The differences are found in the effects on the anterior abdominal wall. I believe this is most important in bilateral breast reconstruction where the disturbance or removal of both rectus abdominus muscles can leave a patient with an incredibly weak abdomen. These patients can also have bulges, feelings of pressure, and abdominal discomfort, that occur even without removal of muscle. I firmly believe that the most natural breast reconstruction appearance is dervied from the patient's own tissue. As I was typing this blog when one of my DIEP Flap patient's came in for a post operative visit. She is doing quite well. So well that I have to remind her that she should take it easy since she is less than 2 weeks after her surgery. I had sent a post out on Twitter regarding some thoughts about DIEP flap reconstruction using both DIEP Flaps for unilateral breast reconstruction. That's right I said use both for the one side. Having done DIEP flaps where I use one half of the abdomen or seventy-five percent of the abdomen to create a breast reconstruction I now feel that in a unilateral breast reconstruction that both DIEP flaps should be used. this way the Plastic Surgeon doesn't waste any of the tissue. In a bilateral case the Plastic Surgeon would be unable to perform the reconstruction in this manner because of the need to reconstruct both sides. Of course this is only my opinion and will not necessarily be shared by everyone. I hope this patient and many of my other DIEP flap patient's both with unilateral and bilateral will allow me to show their photos so that other patients can really understand the size, shape and symmetry that can be achieved with the DIEP Flap.

To date I have performed DIEP Flap reconstruction for patients from several states in the Midwest including Michigan, Indiana, Illinois, Missouri, and Wisconsin. I have even had patients travel from Phoenix, Arizona. My practice still provides care mainly for those patients in Milwaukee, Madison, Kenosha, Racine, Green Bay, Sheboygan, Two Rivers, Janesville, and the surrounding areas of Wisconsin, Illinois and Michigan.