I have seen several patients recently after immediate breast reconstruction with a DIEP flap.  i am always impressed at how natural the appearance of the flap is in relationship to the other breast.  Many times I care for patients in other communities such as Greenbay, Sheboygan, Two Rivers, Appleton, and Madison, Wisconsin after mastectomy.  Many patients travel to have these procedures done at Froedtert and the Medical College of Wisconsin.  There is an entire team devoted to women with breast cancer.  Our goal as Plastic Surgeons is provide all available breast reconstruction options to each patient.  Many of our patients choose the DIEP flap because of our experience with the procedure.  We having been performing this procedure routinely over the past five years at Froedtert and the Medical College of Wisconsin.  Whether we need to perform simultaneous reconstruction of bothe sides or perfor a stacked or double diep flap on one side we have the team available.

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.