Other Flap Options
The Stacked DIEP Flap is where both sides of the abdomen (two DIEP flaps) are used to reconstruct one breast. It is an option for unilateral breast reconstruction in woman who do not have sufficient fatty tissue for a single DIEP flap breast reconstruction.
This technique provides the opportunity for woman, who usually are not candidates for abdominally based breast reconstruction, to receive DIEP flap reconstruction.
Dr. Theresa Wang and Dr. Samuel Shih are amongst the most experienced in Georgia in Stacked DIEP Flap breast reconstruction. This allows women with insufficient fatty tissue, who need reconstruction of only one breast, the option of DIEP flap reconstruction.
The SIEA flap does not violate the abdominal fascia or muscle at all. It is essentially a tummy tuck, with preservation of the blood supply to the abdominal skin and fat. The blood supply, Superficial Inferior Epigastric Artery, does not run through the abdominal musculature like the DIEP flap and therefore no violation of the abdominal fascia and muscle is needed at all. While this would make this the ideal flap, the SIEA is frequently too small to provide robust bloody supply to the flap. Given the potential benefits, the SIEA and SIEV is dissected out and examined in every patient undergoing abdominally based free flap reconstruction of the breasts. The SIEA flap will be offered to our patients based on our intra-operative findings.
EXTENSION FLAPS – DIEP-DCIA
There are women who require a little more fatty tissue, that cannot be provided by DIEP flaps alone, to achieve their desired size. These women may have the option of a DIEP flap with DCIA extension. This is where the DIEP flap is extended to another zone supplied by the Deep Circumflex Iliac Artery. This adds an additional microvascular connection thus allowing for more blood flow to the larger flap.
Abdominally based free flap breast reconstruction is dependent on the availability of skin and fat from the abdomen. Some woman are not candidates given their prior surgical history such previous abdominoplasty “tummy tuck” or major abdominal surgery. Others, simply do not have enough fatty tissue to reconstruct the breast.
There are other donor sites that can be considered for some patients:
TUG FLAP - Transverse Upper Gracilis Flap – taken from the upper middle thigh
PAP FLAP - Profunda Artery Perforator Flap – taken from the back of the thigh “banana roll"
SGAP FLAP – Superior Gluteal Artery Perforator Flap – taken from the upper buttock
IGAP FLAP – Inferior Gluteal Artery Perforator Flap – taken from the lower buttock