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Updated: March 2011

DIEP Flap to Correct Capsular Contracture

pre-operative-failed-implant-reconstruction-front
Completed reconstruction one year after left DIEP flap front
Before
After

This patient is seen before and after left breast reconstruction with a DIEP flap to correct an unsatisfactory left breast implant reconstruction. Before corrective surgery, the left breast implant is too small and too high. The implant is tight and uncomfortable due to capsular contracture. After the DIEP flap she has a natural and symmetrical outcome.

Lorraine's Breast Reconstruction Story:

 

I was diagnosed with breast cancer in 1989. The treatment was a left modified radical mastectomy with direct implant reconstruction followed by chemotherapy. The completed reconstruction was less than perfect; I was no longer able to sleep on my left side. I could feel the edges of the implant which made it extremely uncomfortable. Overtime, the implant also shrunk to almost nothing and I had to wear a small prosthetic just to even out the look of my clothes.

I wanted to have the implant exchanged at the 15-year mark but my husband became very ill and my focus was on caring for him. After his passing, my 20th year post-mastectomy, I began thinking about the surgery again. I had heard about a particular breast reconstruction surgeon from another patient in my oncologist’s waiting room. I also asked a number of physicians about this plastic surgeon and the consensus was that he was an excellent choice for the reconstruction surgery.

At my first visit, I spoke with him about exchanging the implant. He offered me a better type of reconstruction called DIEP flap breast reconstruction. After reading about it on this resource web-site, BreastReconstruction.org, I thought it would be a big improvement over a new implant and one that would not require future surgeries on this breast.

I am so very pleased with the outcome. When I look in the mirror now, I have a new breast that not only LOOKS like a complete breast with a nipple, but it also FEELS like a breast. Another benefit of this procedure is that I can once again sleep on my left side which now feels perfectly normal.

My experience with the plastic surgeon who performed the reconstruction has been a very positive one. From my very first visit, he made me feel comfortable and inspired confidence with his extensive knowledge of reconstruction procedures. He answered all of my questions before and after surgery. I am happy to have found him and I am extremely pleased with the outcome.

 

Photos and Doctor Commentary

 

 pre-operative-failed-implant-reconstruction-front

pre-operative-failed-implant-reconstruction-hr pre-operative-failed-implant-reconstruction-hl

pre-operative-failed-implant-reconstruction-right pre-operative-failed-implant-reconstruction-left

 

Pre-operative

This is how Lorraine first presented for evaluation. She previously had a left mastectomy with implant reconstruction and she developed severe capsular contracture of her reconstructed breast. This has resulted in significant discomfort and asymmetry. She was found to have sufficient abdominal tissue for an autologous flap reconstruction, using her own body’s fat and overlying skin from her abdomen to reconstruct her breast.

 

Markings for left implant removal and DIEP flap

Markings for left implant removal and DIEP flap

The plan was to begin with implant removal, capsulectomy (excision of capsule and scar surrounding the implant), and lowering of her breast fold on the left. Simply replacing the implant for a new one was not an ideal solution. In order to maximize her result and provide her with the best match for her existing right breast, filling the breast skin envelope with her own body tissue was planned using a DIEP flap. The skin from just above the belly button to just above the pubic region is marked for elevation. This flap can then be removed along with the necessary blood vessels and transferred to the left chest where the blood supply can be re-attached under the operating microscope. This makes it possible to create a soft, supple reconstructed breast.

Four months after left breast reconstruction with DIEP flap

This is Lorraine early after her left breast reconstruction with a DIEP flap. The circular patch of skin on the left breast is from the abdomen. This large patch of skin was needed to accommodate the volume of tissue donated by her abdomen in order to give her the appropriate size breast to match her right side. The abdominal scar is still red now because it is fairly new, but it will fade over time.

 

Markings for revision and right breast lift at four months

Markings for revision and right breast lift

In order to achieve maximum symmetry, Lorraine required a minor breast lift on her right side. She is also marked here for a staged procedure in which fat is harvested from her abdomen and transferred to fill a concavity of her upper chest on the left side.

 

Healed right breast lift with markings for left nipple reconstruction

Healed right breast lift with markings for left nipple reconstruction

Here Lorraine is marked for her nipple reconstruction using a modified skate flap technique. This does not require the use of any additional skin from elsewhere on her body. A minor correction of her right lower breast lift incision is planned in addition to the second stage of her fat injection along the upper left breast.

 

Completed reconstruction one year after left DIEP flap front 

 Completed reconstruction one year after left DIEP flap front hr  Completed reconstruction one year after left DIEP flap front hl

Completed reconstruction one year after left DIEP flap front left  Completed reconstruction one year after left DIEP flap front right

Completed reconstruction one year after left DIEP flap

Lorraine now has excellent breast symmetry with a natural, soft reconstructed left breast. Also, she can boast about her flatter abdomen which did not cost her the use of her abdominal muscles. She has no functional loss and her scars have faded.