At The Breast Center Park Meadows Cosmetic Surgery, we are proud to offer several types of breast reconstruction. Our ultimate goals are to help women restore their sense of self, well-being, sensuality and femininity during this difficult time while helping to maximize the aesthetic outcome as well.
Unique to the Rocky Mountain Region, Dr. Jeremy Williams and Dr. Christopher Williams offer the latest, state-of-the-art techniques in breast reconstruction, including Autologous Tissue Breast Reconstruction. Autologous Tissue is tissue used from a patient’s own body — most commonly fat, skin, and sometimes muscle. The tissue is taken in the form of a flap — a flap being that skin, fat, and muscle taken from one area of the body and relocated to another location on the body, carrying its own blood supply. There are two forms of flaps used today in breast reconstruction — Pedicled and Free Flaps.
A Pedicled Flap is a flap that has been rotated or moved from its original location to reconstruct a defect nearby, without losing that blood supply. These flaps were developed about 30 years ago and are still viable choices in breast reconstruction. A Free Flap is a flap whose blood supply is cut to move the tissue a longer distance for relocation. The blood supply (artery and vein) must be reconnected, using a microscope, once the flap is placed in its new location. Free flaps are newer techniques, developed about 20 years ago, and since have become frequently used in breast reconstruction.
Experienced in Advanced Flap Reconstruction Techniques
Dr. Jeremy Williams and Dr. Christopher Williams use microsurgical techniques to move free flaps and reconnect the blood supply. They were two of the first surgeons to offer the DIEP Flap in the Rocky Mountain region and are recognized as pioneers and leaders in the state of Colorado in the area of perforator (muscle sparing) breast reconstruction.
They use a surgical microscope to help them reconnect the veins and arteries from the flap of the body with the relocated tissue on the chest. Without this connected blood supply, the tissue would not survive. Perforator-Based Microsurgical Breast Reconstruction is the most current and state-of-the-art technique in breast reconstruction. This procedure is slightly longer than other flap methods of reconstruction because the blood vessels must be dissected from the muscle — it takes a high degree of skill to complete this, and there are only approximately 60 surgeons (less than 5% of all Plastic Surgeons) in the United States who perform this surgery.
It uses both muscle-sparing and nerve-sparing techniques in an effort to limit the damage to donor sites. At these donor sites, only the artery and veins (these are the blood vessels which “perforate” the muscles) are harvested. The muscles and nerves are left intact — this takes additional time and effort during surgery, but the surgeons at The Breast Center Park Meadows Cosmetic Surgery feel it is necessary to limit the damage to donor sites in breast reconstruction if possible.
Why We Prefer the DIEP Flap
The DIEP Flap (Deep Inferior Epigastric Perforator) is the preferred method for Autologous Breast Reconstruction performed by Dr. Jeremy Williams and Dr. Christopher Williams at The Breast Center Park Meadows Cosmetic Surgery. The DIEP flap is the preferred choice largely because it is taken from a woman’s lower abdomen in a similar manner to a “tummy tuck”.
The excess skin and fat from the lower abdomen is removed and used to reconstruct the new breast. Unlike other techniques that remove muscle with the skin and fat, the DIEP flap preserves a woman’s abdominal musculature. In addition to preserving the muscle, our surgeons strive to preserve the nerves to the muscle (nerve sparing DIEP flap). You can view photos of patients who have elected to have the DIEP Flap in our Before & After Gallery.
If you wish to diminish the appearance of DIEP flap scars, then embrace® scar therapy may be right for you. These adhesive sheets are worn over your scars, where they stabilize the skin and prevent tension. Skin that is being pulled and made taut is what forms the scar in the first place. These silicone sheets also hydrate and rejuvenate the skin in the scar area.
Candidacy for DIEP Flap Reconstruction
There are several factors which help qualify a woman to undergo the DIEP Flap method of breast reconstruction. Your surgeon will help go through the different options for you during your consultation at The Breast Center Park Meadows Cosmetic Surgery and ultimately determine if you are a candidate for the DIEP Flap.
Women who are the best candidates for the DIEP Flap are women who desire to have reconstruction and have extra tissue, skin, and fat in their lower abdomen for use as a donor site and desire a better abdominal contour, similar to that of a tummy tuck. These women understand the risks associated with all flap techniques and have determined that the DIEP Flap offers a lower risk of abdominal weakness or bulging, but that this “investment” will likely produce a more natural, longer-lasting result than other methods of reconstruction, including implant-based reconstruction. These women usually have few serious medical problems and have enough emotional strength and support to be able to cope with the possible loss of a flap (less than 3% risk of flap loss).
We have several women who have volunteered to be contacted by other patients to discuss any questions or concerns candidates may have — those lists are available at our office. These women have finished reconstruction and can offer personal insight, suggestions, and helpful tips to women starting the reconstruction process.
What to Expect after Autologous Breast Reconstruction
Progress with a light diet. Smaller, more frequent meals will help prevent bloating. Limit caffeine and chocolate for the 1 week.
A wire will be attached to each flap of post-operative monitoring while in the hospital. You will have a drain in the breast and both sides of the abdomen (DIEP Flap) or the Latissimus Site (Latissimus Flap). A drain kit with instructions and teaching by the nursing staff will be provided at the hospital. Empty and record (in “cc” amounts) the drainage amount once or twice per day after discharge from the hospital and bring your drain record with you to each clinic appointment.
All of your sutures will be under the skin. You will either have a layer of skin glue that resembles clear nail polish or steri-strips, similar to tape, on all of your incisions. Please do not remove the steri-strips. Your surgeon will remove the dressings, if needed.
Pain & Swelling:
While in the hospital, your pain will be monitored very carefully. Pain medication will be prescribed to you to use as needed postoperatively. You will have a pain catheter in your abdomen to help with pain control. It uses a numbing medication, not a narcotic. It is often removed at home by the patient or family. If you leave the hospital with pain catheters in place, the nursing staff will teach you to remove them. Pain is best controlled with lower doses of multiple medications such as Tylenol, Celebrex and narcotics.
You can expect moderate swelling in the reconstructed breast, underarm and abdomen. You will have numbness in the reconstructed breast and abdomen for up to 12 months. You may experience tightness in the abdomen for the first 3 months – the abdominal binder will help support this donor site.
You will have an abdominal binder around your waist to help support your abdominal donor site. Please wear this for 3 to 4 weeks. If desired, you may switch to a control-top garment (Spanx) for prolonged wear. Do not wear a compressive bra for the first 3 weeks. You may wear a light camisole for gentle support.
You may shower and wash your hair 48 hours after surgery. Shower only for the first 30 days post-operative. Try to keep the shower directed at your back and not at your incision or dressing. It is okay if the dressing gets wet in the shower. Pat it dry after your shower. For the first 4-6 weeks after surgery, do not submerge in a bathtub, pool, or hot tub. Support your drains in the shower around your neck or waist.
Take pain medication as needed for up to 4 weeks in moderation and at night if needed. While you are taking pain medicine, you are encouraged to follow a high fiber diet or take a stool softener such as Colace (available over the counter), as pain medications tend to cause constipation. Do not take Motrin/Ibuprofen or Aspirin products for 1 week after surgery. Ask your surgeon when you may resume your blood thinning medications. All other prescription medications may be resumed immediately, as discussed with your physician.
During the first 2 weeks, place pillows under your head and knees. Sleeping in a recliner may be most comfortable to keep the upper body supported. After the first 2 weeks, sleeping on your side and back is permitted, but not on your stomach. After 4 weeks, resume normal and comfortable sleeping positions.
You may walk and climb stairs immediately following surgery, but avoid standing straight at the waist for 1 week. After 2 weeks you may resume moderate activity such as brisk walking.
No sexual activity for 3 weeks. During the first 4 weeks, do not lift anything heavier than a gallon of milk (10 pounds). No heavy exercise for 4 weeks (tennis, yoga, pilates, jogging, aerobics, weights, etc.). After 6 weeks you may resume more strenuous aerobic work and lifting activities. No abdominal exercises for 8 (+) weeks.
No driving for 3 weeks after your procedure or longer if you are taking pain medicine.
Smoking, Alcohol, & Cannabis Use:
Do not smoke for the first several weeks after surgery as it impedes wound healing and can lead to serious wound complications. Consumption of these substances is dangerous while taking pain medicine. It has a tendency to worsen bleeding. If you use cannabis/marijuana, please discuss with your physician.
Most patients stay in the hospital for 2 to 3 days post-operatively. Your first follow-up visit will be 1 week after surgery. Drains will be removed during one of the first few visits, depending on the output of fluids. Your surgeon will then see you at appropriate intervals after this to monitor your progress.
A prescription for physical therapy will be given to you at either your pre-operative appointment or your first post-operative appointment. Gentle range of motion exercises are encouraged during the first 2 weeks.
Work and Travel:
Depending on your career and your rate of healing, you should be able to return to work within 4 to 6 weeks of surgery. If your job involves heavy lifting, please allow 8 to 12 weeks before returning to work. Your surgeon will be able to give you a better estimate depending on your physical and professional profile. Flying or traveling is permitted after the first week as tolerated.
Call your surgeon immediately if you experience any of the following: excessive pain, rapidly expanding swelling under the skin, bleeding, redness at the incision site or pus drainage from incision, spreading bright pink discoloration, or fever over 101.5° F.
Call 911 if you are experiencing a life-threatening emergency. Such symptoms include severe shortage of breath, chest palpitations, sudden or sever chest pain, or other life-threatening concerns.
To schedule a consultation to learn more about the DIEP Flap, please call 720-457-4461 or schedule an appointment online.