DIEP candidate with previous abdominal procedures
There have been much interest in a woman’s candidacy for abdominal flap procedures if previous abdominal surgery has been done. Especially with c-sections, many women have been told that they are not candidates for the DIEP flap. Often times with low-transverse incisions (Pfannenstiel) incisions, the Superior Inferior Epigastric Artery (SIEA) has been transected.
A recent study has looked at DIEP flaps being performed after such incisions. While, if in fact the SIEA has been cut, it has actually improved circulation to the Deep Inferior Epigastric Artery Perforator (DIEP) system and augmented its vascularity and survival rate. Unfortunately, there are rare instances that the DIEP artery system has also been transected, such as in the aforementioned cases, appendectomy, hysterectomy, exploratory laparatomy, cholecystectomy, etc. These should be assessed on an individual basis and discussion/tests performed prior in order to speak abou the DIEP flap. Physical examination, Doppler ultrasound, and CT angiograms can help to visualize the vascularity of the abdominal flaps prior.
All in all, abdominal procedures are not a contraindication to abdominal flap breast reconstructions such as the DIEP, but should be assessed by a skilled surgeon in such flaps. “Flaps raised from these abdomens are not only safe, but may be better vascularized”.
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