Ask expert breast reconstruction microsurgeon surgeon, Dr. Joshua Levine your questions:

Do you have questions about breast reconstruction surgery? If you’re making decisions about reconstruction, you may be seeking answers and guidance. Breast surgeon, Dr. Joshua Levine, a pioneer in the field of perforator flaps, answers common questions about breast reconstruction. You can also call our office at The Center for Reconstruction located in New York, New York with questions, and schedule a private, in-person consultation. Submit your questions using our contact form here.

All patients having a mastectomy should know their options for breast reconstruction. Almost any patient who is a candidate for breast reconstruction is a candidate for natural breast reconstruction using your own body tissue to recreate the breast (autologous breast reconstruction).

Most women who chose autologous breast reconstruction are candidates for DIEP breast reconstruction. The DIEP uses the patient’s’ own extra abdominal skin and fat to make a new breast. There are five things to consider when trying to decide if the DIEP is the right choice for each individual.

Current Health

All healthy patients are offered autologous breast reconstruction. If a patient is a current smoker or has multiple medical problems, she must understand that her risk of complications may be increased. We will work with the patient and her medical doctor to minimize risk, so that we offer autologous reconstruction to almost every patient facing mastectomy.

Body Shape

If a patient is very thin and has very little extra abdominal tissue to donate to reconstruct her breasts, the abdominal donor site can be extended to maximize volume harvested (SHaEP flap). If extension still does not produce enough donor tissue, the abdomen may be used in combination with other donor sites (Four Flap procedure, or Stacked flaps). If carries more extra fat in other areas, there are many other donor options that may be considered, such as the thigh (PAP flap), the buttock (GAP flap), lower back (LAP flap).

Past Surgeries

Many women have had prior abdominal surgeries, such as Cesarean Section, or laparoscopic cholecystectomy or oophorectomy. This is rarely a problem, because these surgeries do not typically disrupt the main blood vessels that supply the DEIP. All patients undergo an MRA, which is an special study that shows us exactly which blood vessels we will can use. This study will determine if prior surgery has resulted in any difficulties in performing the DIEP. In the rare event that the abdominal blood vessels are inadequate, other donor site options will be discussed.

Treatment Needs

Most thin women do not require much volume to reconstruct their breasts, and there is typically enough abdominal tissue, even in very thin women. If a patient is very thin and wishes to have relatively a large breast reconstruction, the DIEP may need to be extended or augmented by another flap procedure. Breasts reconstructed with a DIEP can also be augmented with fat grafting in the future.

Personal Preferences

Every patient should understand all of her options and make the decision that is most appropriate according to her anatomic limitations and personal preferences. Some women who might be able to use their abdominal tissue may not chose to do so for personal reasons. These women may chose a different donor site because they do not want a scar on their abdomen. choosing a donor site is a personal decision which can be best made only after considering all of the options, and understanding the pros and cons of each.

In Conclusion

Perforator flap breast reconstruction is highly advanced, sophisticated surgery that requires a great deal of extra training and experience to perform with consistent success. Although the DIEP is the most common perforator flap performed, it is still a complex operation and should be done by a surgeon who specializes in perforator flap procedures.


No matter how big or how small your needs are – we are here for you.
From the moment you call our office, we will work with you to make sure
you have all of the information you need to make the best decisions
about your breast reconstruction.

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