Breast reconstruction, the act of surgically restoring the form of the breasts following a mastectomy, requires a balance of surgical skill, innovation, and aesthetic vision. In our next two blogs, we’ll discuss how our surgeons Dr. Somogyi and Dr. Jalil refine the aesthetics of breast reconstruction for the best possible results.
In general, there are two types of breast reconstruction: implant-based reconstruction, and autologous reconstruction (meaning the use of your own tissue to recreate the breast). You can learn more about the different types of reconstruction here.
One autologous reconstruction technique is called a DIEP flap, and involves removing tissue from the lower abdomen and transferring it to the chest for the purpose of reconstructing new breasts. Using your own tissue can result in a more natural feeling and appearing breast. To further improve the appearance of the breast and particularly the appearance of the tissue donor site, this surgery can be complemented by several adjuncts which we’ll discuss here. (Note that these add-ons may not be covered by OHIP.)
1. Diastasis Recti Repair
A diastasis recti is a separation of the abdominal muscles, often as the result of natural distension of the abdomen during pregnancy. This separation can create the appearance of a bulge in the abdominal area that cannot be addressed with diet or exercise. A diastasis can be repaired during a DIEP flap surgery to help create a flatter abdomen and improve the overall outcome, with a single recovery period.
2. Lipocontouring
Another beneficial option is to add liposuction to your treatment plan. Liposuction is an excellent way to sculpt the flanks and the abdomen following your DIEP flap to ensure that the upper and lower areas have an even contour. Liposuction can also be used to graft fat to the breast following reconstruction for a smoother contour. This is achieved by harvesting fat, then preparing it for re-injection and placing it where needed through a narrow injection cannula.
Although liposuction is often performed at the same time as other surgeries such as tummy tucks, the risk profile is higher when it comes to combining liposuction with a DIEP flap. Therefore, a liposuction procedure would be scheduled separately and subsequently to a DIEP flap.
3. Drain Free Healing
Finally, we can improve the healing of scars with the use of the drain-sparing or drain-free technique. Drains are sometimes inserted following certain surgeries to collect and remove post-operative fluid buildup. We can eliminate the need for drains and instead use a special type of stitch that decreases the amount of tension across the incision. When this tension is offset, hypertrophic scarring becomes less likely.
It’s important to note that the results of a DIEP flap will not be identical to those of a tummy tuck, which is a cosmetic procedure aimed at removing excess loose skin from the abdominal area. Because a DIEP flap has a different objective, namely that we need to remove a certain amount of tissue for reconstruction, the incision cannot be as low and as concealable compared to a tummy tuck. However, with the techniques noted above and our surgical proficiency, we can create quite a comparable result.
Below is an example of a patient who underwent autologous DIEP flap reconstruction with Dr. Jalil, and whose results could easily be confused with a cosmetic tummy tuck—a testament to our level of surgical skill and care.
Before and After DIEP Flap Reconstruction
Before and After DIEP Flap Reconstruction
Final results, with incision hidden in underwear line
To learn more about your breast reconstruction options, you are welcome to book a consultation with our surgeons.
