- Question from DCannis: Due to failed implant and radiation, I am not a candidate for another implant. I am being told by plastic surgeons that I should have the TRAM, as the DIEP would fail due to the vessel that they would need to attach it to having been radiated. The plastic surgeons in my area do not do the DIEP. I am willing to travel, but really need to know what the true success rate would be.
- Answers - Carolyn Chang The DIEP flap is something that has come into vogue lately. With a DIEP flap, the issue is micro-surgery. In the radiated area, the vessels that one would need to use to hook the flap to would be in the radiated chest area. Therefore, the flap success rate becomes harder because the micro-surgical technique becomes more difficult. If you want a more reliable reconstruction, the pedicle TRAM is a safer alternative with almost 100% success rate, even in radiated patients.
- Lillie Shockney, R.N., B.S., M.A.S. Surgeons who specialize in DIEP flap will assess that vessel before cutting it to see how viable it is. If it looks pretty good, they'll go ahead and harvest it and do DIEP. That judgment call isn't able to be made until you're on the operating room table.
- Carolyn Chang You need a center such as our micro-surgical center in San Francisco that is very specialized, or you need a university setting. It's a matter of what you want to invest in, whether you want to travel or stay local. I feel very strongly that, for the vast majority of patients, a pedicle TRAM is an outstanding reconstruction with a very low rate of abdominal complications. I have marathon runners, competitive athletes, and iron man people who have had them and have no problems with anything they do. It depends on how well the belly is closed, and that takes a certain amount of expertise.
On Wednesday, April 20, 2005, our Ask-the-Expert Online Conference was called Reconstruction and Safe, Sexy Cosmetics. Carolyn C. Chang, M.D., Anna-Dee Rinehart, S.C.S., and moderator Lillie Shockney, R.N., B.S., M.A.S. answered your questions about reconstructive surgery and safe, sexy cosmetics.
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