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Breast cancer reconstruction can be challenging for the Plastic & Reconstructive surgeon as well as the patient. In the patient with “ptotic” breasts, where the nipple areola complex is significantly below the inframammary fold or breast crease, the nipple cannot be safely kept during a mastectomy based on significant impairment in blood supply. In these cases, when the nipple is removed, we use a skin pattern that allows the breast to have a more lifted or “perky” appearance.

The DIEP flap allows the skin and fat from the abdomen that is normally discarded in a tummy tuck to be transferred to the chest with microvascular anastomosis to the internal mammary vessels behind the third rib. The abdominal donor site is closed in a manner similar to an abdominoplasty.

The photograph demonstrates before and after bilateral mastectomy and breast reconstruction with bilateral DIEP flaps from the abdomen.