With a stacked-DIEP flap procedure, two DIEP flaps—one DIEP flap from each side of the abdomen— are used to reconstruct a breast of a larger size than could be reconstructed with just one DIEP flap. (A) The blood vessels that supply each individual DIEP flap are meticulously separated from the abdominal muscle, leaving the muscle intact. (Inset) Cross sectional view of stacked DIEP flaps showing the blood vessels of each individual flap interconnected to one another in preparation for transfer to the chest. (B) The stacked-DIEP flap is transferred to the chest and, using microsurgical techniques, connected to blood vessels at the recipient site that will nourish both DIEP flaps. (C) The horizontal abdominal scar that results following stacked-DIEP flap surgery is similar to that created by a “tummy tuck.” The scar that results on the breast will depend upon the technique used for mastectomy.
Stacked-DIEP Flap is an innovative approach for women who thought they are too thin to have a breast reconstructed using their abdominal tissue
The Stacked-DIEP flap, also called a double DIEP, allows a breast to be reconstructed with significantly more tissue than can be obtained with either a single DIEP flap or a TRAM flap. This sophisticated microsurgical procedure can be an option, for example, for a thin woman who needs reconstruction of only one breast. Women who have been told that they are not candidates for a TRAM flap or a DIEP flap because they “do not have enough tissue” or because they have a vertical midline scar may be candidates for a stacked-DIEP flap reconstruction.
The Stacked-DIEP flap procedure uses two DIEP flaps (one DIEP flap from each side of the abdomen) to reconstruct a single breast. As is the case for all perforator flaps used in breast reconstruction, no muscle is sacrificed with this procedure. After the tissue is transferred to the chest, the blood vessels that supply the tissue of each of the flaps are connected to vessels at the recipient site using microsurgical techniques. The two flaps are then “stacked” and sculpted to restore the breast removed by mastectomy. Recovery is the same as it would be for any abdominal perforator flap.
The blood vessels that are used for Stacked DIEP flap breast reconstruction are meticulously dissected without removing or destroying the muscle of the abdomen. Because muscle is preserved, postoperative pain and discomfort are minimized, and strength and function are preserved. After Stacked DIEP flaps are transferred to the chest, the blood vessels that will nourish the two DIEP flaps are connected to blood vessels at the mastectomy site using delicate microsurgical techniques. When possible, sensory nerves may also be connected to facilitate recovery of sensation in a reconstructed breast. Finally, the skin and fat of the Stacked DIEP flaps are shaped into a new breast.
Because the tissue removed from the lower abdomen during Stacked DIEP flap breast reconstruction surgery is similar to that removed during a tummy-tuck, women who undergo this procedure generally benefit from an improvement in the contour of their abdomen. While typically not as low as the scar of a tummy-tuck, the scar that results following Stacked DIEP flap surgery can typically be concealed in most clothing and in a once-piece bathing suit.
Approximately three months after the initial stage of breast reconstruction surgery, refinement of breast shape and procedures to produce overall symmetry can be completed. These optional additional procedures are performed on an outpatient basis and are referred to as Stage II.
Contact us if you would like more information about the options for breast reconstruction after mastectomy or to schedule a consultation. Our practice has offices in New York City and Greenwich, Connecticut.