Questions for Your DIEP Flap Surgeon

Since you only have one opportunity to have a DIEP flap, you should choose your surgeon wisely. Experience and track record matter greatly. Surgeons with limited experience often damage or include large segments of muscle. Here are some questions to ask:

View Patient Photos Find Out If You Are a Candidate

How many DIEP flaps have you personally done?

The prospective patient should know how many flaps their surgeon has performed. This should not include flaps that the surgeon has assisted on or watched as a resident.

I personally have done over 1,000 DIEP flaps for breast reconstruction surgery.

What is your success rate?

By this I mean how many flaps have ended up healthy and without large areas of fat necrosis (firm area).

My personal success rate is better than 99.5%.

How often does the DIEP flap get converted during surgery to an operation that includes muscle (TRAM or free TRAM flap)?

If a single breast is being reconstructed either side of the abdomen can be used for the reconstruction. At least one side of the abdomen should include good perforator blood vessels. In that situation, it would be highly unlikely to ever include any muscle. If both breasts are being reconstructed and both flaps are necessary, and the perforating blood vessels are very small, then there is the possibility that muscle might be included with the flap to ensure success of the operation. Surgeons with a more limited experience are more likely to include muscle. It has been years since I have found it necessary to include muscle with any DIEP flap.

What is my risk of abdominal hernia? How often does synthetic mesh get used in the abdominal closure?

The risk of abdominal hernia with a TRAM flap in the plastic surgery published literature is as high as 40%. The risk or hernia with the DIEP flap should be less than 1%. My abdominal hernia rate is 0.5%. Mesh is a permanent, synthetic, screen like material that is used to close and strengthen the abdomen. It is placed to repair or prevent a hernia. Mesh is routinely used in TRAM flap surgery. Some "DIEP" flap surgeons use it to prevent a hernia. If a large amount of the nerve supply to the abdominal muscle is cut, the muscle loses its tone and function. This puts the abdomen at risk for hernia. Mesh is used by the "DIEP" surgeon to prevent this. This mesh can become infected, cause other problems and complications, and lead to further surgery. With DIEP flap breast reconstruction, mesh should almost never be necessary for abdominal closure. The use of mesh in my practice is extremely rare and I have not found it necessary to utilize mesh in years.

If you have questions about the DIEP flap procedure, please take a moment to read frequent questions. You can also request a phone consultation with me or call the practice at 516-482-1100 to schedule an appointment.

Back to Top