During body lift perforator flap surgery, an incision is made along your bikini line and the surgeons take out the two flaps of abdominal tissue (or DIEP flaps) that they will use in the reconstruction. For now, the team leaves them attached to their blood supply in the lower belly.
Your body is then carefully turned over so that the surgeons can access your hips/upper buttocks. They extend the same incision made on your lower abdomen around to your back, where they remove a GAP flap from either buttock. The incision is made high on the hip and the team removes only as much fatty tissue as is needed. This helps to preserve a nice shape for the buttock and keeps scars hidden under a bikini or underwear. Since the surgeons are using both sides, less tissue can be taken from each donor site, which also helps make it easier to preserve the overall shape. Once the GAP flaps are removed, the surgeons close the donor sites and carefully turn you onto your back.
Next, the team removes the DIEP flaps completely from the lower abdomen, along with their blood vessels, and the abdomen is closed as in a tummy tuck procedure. The surgeons then place the GAP flaps into the breast pocket first followed by the DIEP flaps on top. The tiny blood vessels in the flaps, which will feed the tissue of your new breasts, are matched to blood vessels in your chest and carefully reattached under a microscope. The flaps are also linked together microsurgically to provide blood flow throughout the entire new breast.
Body lift perforator flap reconstruction surgery takes about 9-10 hours.
After body lift perforator flap reconstruction surgery: You'll be moved to the recovery room after surgery, where hospital staff members will monitor your heart rate, body temperature, and blood pressure. If you're in pain or feel nauseated from the anesthesia, tell someone so you can be given medication.
You'll then be admitted to a hospital room. For body lift perforator flap surgery, you usually stay in the hospital for about 3-4 days.
Your doctor will give you specific instructions to follow for your recovery. For detailed information on how to care for the dressings, stitches, staples, and surgical drains, visit the Mastectomy: What to Expect page.
If you had immediate reconstruction, it can take about 6 to 8 weeks to recover from body lift perforator flap reconstruction surgery. Your doctor may recommend that you wear a compression girdle for up to 8 weeks after surgery. Because you've had surgery at multiple sites on your body (your chest, your belly, your hips), you can expect it to take longer to recover than someone having mastectomy alone. You'll have to take care of multiple incisions: on your breasts, your lower abdomen, around your belly button, and your upper buttocks, and you'll probably have drains in your reconstructed breast and in your tissue donor sites. If you had axillary nodes removed during this surgery, you will have another incision under your arm(s).
As with any major abdominal/hip surgery, you may find that it's difficult or painful to sit down or get up from a sitting position. It also might be hard to get in and out of bed. Your doctor can show you how to move until your abdominal area heals. If you have severe pain, ask your doctor about medications you can take.
It's important to take the time you need to heal. Follow your doctor's advice on when to start stretching exercises and your normal activities. You usually have to avoid lifting anything heavy, strenuous sports, and sexual activity for about 6 weeks after body lift flap reconstruction.
It sometimes takes as long as a year or more for your tissue to completely heal and for your scars to fade.