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THIS is why I love doing breast reconstruction!

Before and after DIEP flap breast reconstruction

Before and after DIEP flap breast reconstruction at 6 months postoperatively.

Why do I love doing breast reconstruction, particularly using the body’s own tissue?  These before & after photos say it ALL!

A quick post just to show you how rearranging the body’s own tissue to make a new breast can dramatically change a woman’s life!  This patient waited 2 years after her mastectomies for breast cancer to have breast reconstruction.  Before we met, she just wasn’t ready, and she didn’t want to have any of the procedures that used a foreign body (implants) or sacrificed a major muscle of her body (TRAM flap).  She was busy taking care of her family and as many mothers do, she put herself last.

When we met, she was READY to move forward and to do something for herself!  She was an excellent candidate for the DIEP flap, which stands for the deep inferior epigastric artery perforator flap – the blood vessel that supplies the skin and fat of the lower abdomen.  It is a Microsurgical procedure performed only by specially trained Reconstructive Microsurgeons, and the DIEP is a procedure I usually do every Monday or Tuesday.  Learn more about the DIEP flap here.

While we try to do as many steps of the reconstruction in one surgery, this patient required three procedures from start to finish – one major and two minor:

After bilateral mastectomies for breast cancer but before breast reconstruction

After bilateral mastectomies for breast cancer but before any breast reconstruction.

This woman was a perfect candidate for the DIEP flap.  Her goals were to get her body image back, and return to as close to a pre-cancer state as possible.  She had enough lower abdominal skin and fat to make two new breasts!

Together with my Microsurgical partner Dr. Rudy Buntic, we performed successful bilateral DIEP flap breast reconstructions.  You can see her immediate postoperative photographs below, with the abdominal “donor site” scar hidden low in her underwear, just like a tummy tuck scar.

Soon after this surgery, she was healing well and ready for her second stage of reconstruction.  She had completed the majority of the reconstruction and now had fabulous permanent breast reconstructions that are warm, soft, living tissue without the risks and complications of implants.  And she got a tummy tuck at the same time, all as part of her breast reconstruction!

I emphasize to DIEP patients who are also MOMS to think about DIEP flap surgery as their Mommy Makeover at the same time as reconstructing their breasts.  The design of the abdominal incision is essentially the same in a DIEP flap and abdominoplasty.

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Two months after bilateral DIEP flap breast reconstruction and before nipple and areola reconstructions.  She has pink incisions which is normal for this stage of healing.

Soon afterward, this patient returned to the operating room for a short outpatient surgery where we made two new nipples using skin from the DIEP flaps themselves.  Learn more about nipple reconstruction using local flaps here.

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After nipple reconstruction but before areola tattoo. Small areas of bleeding can be seen where dissolving stitch ends were trimmed at 3 weeks following this outpatient procedure. her abdominal swelling is going down after taking fat from her tummy and breast scars are maturing and fading.

Lastly, this patient had a medical tattoo in the office under local anesthesia to create areolas and to pigment the nipples for a more natural look.  You can see small areas of bleeding immediately after performing the tattoo.  Learn more about areola reconstruction here.  

Immediately after nipple and areola tattoo, an office procedure, small pinpoint areas of bleeding called the "paprika sign" show that the pigment is down far enough into the dermis so that it will stay there for a permanent areola reconstruction.

Immediately after nipple and areola tattoo, an office procedure, small pinpoint areas of bleeding called the “paprika sign” show that the pigment is down far enough into the dermis so that it will stay there for a permanent areola reconstruction.

Here are images of this patient several weeks after her areola tattoo.  She has a PERMANENT breast reconstruction, she has great symmetry of her new breasts, a flatter tummy, a positive body image, and she can now move forward with her life!

Following bilateral DIEP flap breast reconstruction, nipple reconstruction and areola tattoo.

Following bilateral DIEP flap breast reconstruction, nipple reconstruction and areola tattoo.

It is an honor and a privilege to help breast cancer survivors the way I do, and I love my job!  The DIEP flap is currently one of the very best options we as Plastic Surgeons and Reconstructive Microsurgeons can offer our patients.

To learn more about DIEP flap breast reconstruction, nipple and areola creation and other procedures for breast cancer survivors or BRCA gene postive “pre-vivors”, visit the breast reconstruction section of my website.

To schedule a consultation, call 415-923-3067 or complete our online consultation request form today!



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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA