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Updated: December 2008

Left DIEP Flap, Right Muscle-sparing Free TRAM Flap

Left DIEP Flap, Right Muscle-sparing Free TRAM Flap
Left DIEP Flap, Right Muscle-sparing Free TRAM Flap

This patient is shown here before and after bilateral mastectomies and abdominal free flap breast reconstruction. Based on the anatomy of her blood vessels, as identified during surgery, she had a DIEP flap on the left and a muscle-sparing free TRAM flap on the right.

Doris's Breast Reconstruction Story:


My At age 71 having cancer surgery was devastating. The discovery was made when I went for my annual mammogram. Cancer was found in two places in my right breast so I had no choice but to have a mastectomy. After talking things over with my breast surgeon, she mentioned the option of bilateral mastectomies. This way, I wouldn’t have to worry anymore about getting cancer in the other breast.

I now had to see a plastic surgeon. My daughter told me about her plastic surgeon, and I decided to see him. He was very helpful, going over all the different types of reconstruction that were possible for me. I could have had a breast implant or a flap reconstruction. I was shown pictures and was given very detailed information. My problem was that I couldn’t make up my mind if I wanted to lose two breasts or just the one with cancer. My doctor told me to go home and give it some thought and when I made up my mind we would go from there.

In the meantime I spoke to my sister-in-law, who had the same surgery three months earlier. She chose bilateral mastectomies with flap reconstruction. I decided to go the same way, as I couldn’t see myself going through this a second time. Before I had my surgery, my sister-in-law made a trip to New York from Texas to show me her breast reconstruction. I was very lucky to have someone to talk to so that I knew what to expect.

My surgery was performed without any problems and I remained in the hospital for 4 days after the surgery was completed. I was home for 8 weeks before returning to work full-time. I am happy that my reconstruction was done on the same day as my mastectomies. It helped me a great deal to find that I still had breasts when I woke up from surgery. It made me feel normal. I was very lucky to have great doctors and family to see me through my trying time.

I waited one year before having my nipple reconstruction. Having the nipples reconstructed made me feel one step closer to normal. The nipple reconstruction surgery was done ambulatory with a quick recovery. Five months after my nipple reconstruction I had my third and last procedure which was the nipple tattooing. The nipple tattoo procedure was a breeze compared to the original surgery! The tattooing now made me feel whole again.

Even though I was initially reluctant to have more surgery, I am glad now that I decided to continue with procedures two and three, as recommended by my doctors. Also, I am glad that I had decided to go with bilateral mastectomies in order to alleviate any future worries of having to go through this type of surgery again. Now, as a breast cancer survivor, I can say that my great plastic and breast surgeons have given me back my normal life. What more can a women ask for?


Photos and Doctor Commentary


Left DIEP Flap, Right Muscle-sparing Free TRAM FlapLeft DIEP Flap, Right Muscle-sparing Free TRAM Flap

Pre-operative markings for bilateral mastectomies and abdominal free flaps

On the day of her surgery, markings were made for bilateral skin-sparing mastectomies. Markings were also made for bilateral DIEP flap harvest from the abdominal wall. The markings on the upper chest identify the internal mammary vessels which are used as recipient vessels for breast reconstruction once the abdominal free flaps are transferred.


Left DIEP Flap, Right Muscle-sparing Free TRAM Flap

After bilateral mastectomies, right DIEP and left muscle-sparing TRAM free flaps

At the time of her mastectomies, it was determined that the bilateral breast reconstruction could be done with a right DIEP flap and a left muscle-sparing TRAM free flap. This is her appearance one year after surgery.


Left DIEP Flap, Right Muscle-sparing Free TRAM Flap Left DIEP Flap, Right Muscle-sparing Free TRAM Flap

Nipple areola markings                           After nipple areola reconstruction

After healing from her bilateral mastectomies and free flap breast reconstruction, Doris underwent nipple areola reconstruction. Pre-operative markings were made with Doris standing upright to properly locate her nipple areola position bilaterally. Each nipple areola reconstruction was done using a skate flap purse-string technique.


Left DIEP Flap, Right Muscle-sparing Free TRAM Flap



Final breast reconstruction and nipple areola tattoo

Once the nipple reconstruction healed, Doris was able to return for the nipple tattooing process, completed as an office procedure.


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