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Updated: March 2011

DIEP Flap and SIEA Flap,
Prior Mastectomies and Radiation

Pre-op with capsular contracture
Completed reconstruction after one year front

This patient previously underwent bilateral mastectomies and implant reconstruction followed by radiation. Related to the radiation, she developed severe capsular contracture. She is seen here before and after implant removal and breast reconstruction with a DIEP flap on the left and an SIEA flap on the right.

Jennifer's Breast Reconstruction Story:


In May of 2007, my husband and I discovered a lump in my breast. I immediately saw a breast surgeon and had a needle biopsy. Cancer was found in both breasts and I elected for bilateral mastectomies, although I could have had a lumpectomy in one of them. At the time, the only option I was given for reconstruction was using tissue expanders and implants. I went through with the mastectomies and expander reconstruction and had no pain and no difficulty with my recovery. It was an easy two week transition back to work.

Chemotherapy and radiation on both sides followed without any complications. I was advised to wait six months following radiation to have my expanders inflated which was done without incident. In July 2008, the expanders were replaced with implants as an out-patient procedure; the procedure was simple and not painful. One week later, I felt strange… as if something was coming out of my breast. It was the IMPLANT. The breast pocket had opened and the implant fell out into my hand! I immediately had surgery to clean out the wound. The following week I was in the hospital again, this time to replace both implants with smaller ones.

Two and a half months later, I started to experience a piercing pain on my right side, as if someone were drilling under my arm. Needless to say, I was very distraught. The plastic surgeon informed me that he had no idea what the source of the pain was and his suggestion was to send me to a pain management physician. I followed through with the referral and this new physician prescribed amitriptyline and dilaudid which decreased the pain. Once I was able to function again, my husband (who is in the medical field) and friends began helping me seek out additional plastic surgeons for their opinion. I had ten consults until I found the one with whom I immediately felt a sense of confidence and trust.

This new plastic surgeon quickly diagnosed my situation as capsular contracture combined with tissue that had lost its elasticity due to the radiation. He told me that implants were not the surgery of choice for someone in my situation. He suggested that I could have the implants removed and then opt for abdominal free flap breast reconstruction. I took three weeks to consider this new option. While friends suggested that I merely remove the implants and have no further procedures, I felt the need to move forward for my own self image.

In April 2009, I underwent removal of my implants with free flap breast reconstruction from my abdomen. I awoke tired, but walked around the hospital on the second day after surgery!

I was feeling great, but a week and a half after my surgery, the incision began to open as a result of a pocket of fluid. This was quickly resolved. It was five weeks until I was able to drive.

Now that I am fully healed, I am so excited to show off my beautiful breasts; they are beyond anything I would have imagined. At 65 years young, I marvel each day at the results and consider myself very fortunate… I feel like I’ve been given a special gift. Even my husband says that I can wear a bikini… now that’s a real gift!


Photos and Doctor Commentary

Pre-op with capsular contracture

Pre-operative with capsular contracture

Jennifer presented for the first time in consultation with a history of bilateral implant based breast reconstruction. In addition, she had previous bilateral breast radiation which resulted in severe capsular contracture. Her implants had already been exchanged once for a smaller size in an attempt to resolve multiple post operative complications. Knowing that the risk of capsular contracture is much higher in the setting of radiation, exchanging the implants again was not considered a good option.


Markings for Free Tram

Breast and abdominal markings

Although Jennifer was found to have a thin body habitus, she did in fact have sufficient abdominal tissue for bilateral abdominal free flap breast reconstruction. She is shown here with markings delineating the desired inferior folds of her breasts. The abdominal donor site is marked as well, each half going to create one breast. It was apparent that radiation had taken its toll on Jennifer’s breast skin and that what remained was extremely thin and damaged. The plan was to use the tissue from her abdomen, including large areas of non-radiated skin, to substitute for the volume of her breasts and to provide the ideal setting for future nipple reconstruction.


6 Months after Nipple  Reconstruction

Six months after nipple reconstruction

This is Jennifer after her implants were removed and her breasts were reconstructed with bilateral abdominal free flaps. As it turns out, she ended up with an SIEA free flap on the right side and a DIEP free flap on her left. The choice of flap is something that was determined during surgery based on the anatomy of her blood vessels, and does not make an aesthetic difference at all. One month after the breast reconstruction, her nipples were reconstructed and she is now ready to have her nipple areola tattoo procedure.


Completed reconstruction after one year front 

 Completed reconstruction after one year hr  Completed reconstruction after one year hl

   Completed reconstruction after one year left  Completed reconstruction after one year right  

Completed reconstruction after one year

Jennifer is seen here one year after her initial consultation for revision of her implant based reconstruction. She has had nipple tattoos done as an office based procedure with local anesthesia only and has chosen a light hue to match her original, natural light color.