FAQ's

What are the major benefits of the DIEP procedure over other breast reconstruction procedures?

The DIEP flap is the most advanced technique for autologous breast reconstruction because unlike the older technique of pedicled TRAM flaps, the abdominal muscles are left intact. This will maintain greater abdominal wall strength after your surgery. There is also reduced risk of developing a hernia or bulge after DIEP than pedicled TRAM flap. This is the procedure of choice for bilateral breast reconstruction.

Unlike the traditional TRAM flap, the DIEP procedure spares the rectus abdominis muscle (or the "abs"), because it is based on small vessels that are microscopically separated from the muscle, leaving it uninjured. The rectus muscle acts as a counterbalance for the spinal muscles, and is important in straight posture as well as sitting activities.

Who is a candidate for these procedures?

Most women who have had a complete or complete or partial mastectomy (removal of all or some of the breast tissue and nipple) are candidates for breast reconstruction. If you have had, or will need radiation therapy to the breast, it may affect the type of reconstruction, and when you can have it. Some patients will need chemotherapy after their mastectomy, and this too can affect the timing of your reconstruction. However that being said most women are candidates for some form of breast reconstruction.

What determines which procedure is performed and when is this decision made?

There are many factors that go into the decision making process and they include:

1. Your own personal desire to use implant or your own tissue.
   
   
2. Whether you have had radiation to your breast or chest wall will affect what type of procedure can be performed. Generally, if you have had previous radiation, then either a DIEP flap or Lat flap with a tissue expander are the favourite options.
   
   
3. Your body shape and whether you carry enough weight on your tummy to allow your own tissue to be used for reconstruction.
   
   
4. The timing of the procedure, whether you are having immediate or delayed breast reconstruction. Just remember that there are more options available to you if you are having immediate breast reconstruction.
   

Do insurance companies cover breast reconstruction?

Yes. The Ministry of Health will also cover balancing procedures to the opposite breast to match the two sides. However, fine-tuning cosmetic procedures such as liposuctioning of the bra rolls or minor scar revisions are not benefits that the Ministry of Health will cover?

Can these procedures be done immediately following mastectomy? Can they be done following radiation?

If you have early breast cancer and your breast surgeon does not think that you will require radiation to your chest wall after surgery, then you NEED to ask about this option called immediate breast reconstruction. You SHOULD ask your breast surgeon to make a referral to see one of us. If you have already had mastectomy or radiation, then you need to wait a minimum of 6 months before the tissue has healed enough for reconstruction.

Will the reconstructed breast be made symmetrical to the existing breast?

A reconstructed breast will not precisely match your natural breast. If you have large breasts, you may need a reduction of your opposite breast in order to match the reconstructed breast. If you have smaller breasts that sag, you may need a lift of the natural breast or augmentation with an implant to improve the shape and symmetry. Both reductions and lifts leave permanent scars on your breasts. The precise location of the scars and technique used to balance the breasts will be explained in great detail by your plastic surgeon when planning for this stage.

What is done for restoring the nipple and areola?

We prefer to allow your reconstructed breast to “settle”for at least 3 months so that the nipple and areola can be placed in the proper position.Nipple/areola reconstruction is done usually with local anesthesia as an outpatient surgery, meaning that you will not need to stay overnight at the hospital. This procedure usually involves very little discomfort. For more details, please go to the procedures section.

Will the reconstructed breast have sensation?

No, your reconstructed breasts will not have sensation. The nerves that go to your breast and nipple will be cut during the mastectomy. They cannot be restored by reconstruction.

How are the long-term results and how is the recovery?

The short and long-term results are excellent. Patients are able to leave the hospital after only one day if implant reconstruction is performed. After a DIEP flap, patients go home after 5 days. After a lat flap, patients usually go home after 2-3 days. When they are home, they resume back to normal activities without heavy lifting or exercising for a minimum of 3 weeks after implant reconstruction and 6 weeks after DIEP flap.