Frequently Asked Questions

What is DIEP flap reconstruction?

DIEP flap reconstruction is a type of breast reconstruction in which your own tissue is used to create a new breast after a mastectomy. A “DIEP” flap is a Deep Inferior Epigastric Perforator flap, which means that skin, fat and tiny blood vessels are taken from the abdominal area and used to create the breast.



What are the benefits of DIEP flap reconstruction?

DIEP flap reconstruction, unlike some other types of flap reconstruction, preserves the abdominal muscles, which reduces the risk of developing an abdominal hernia. There is also significantly less pain associated with a DIEP flap, allowing you to be more mobile and active sooner than with other procedures. In addition, DIEP flap reconstruction involves the removal of skin and fat from the belly, which can improve your abdominal contour ­– similar to the results from a tummy tuck.



Who can have DIEP flap reconstruction?

Most women who are healthy enough to undergo breast reconstruction are good candidates for DIEP flap reconstruction. Active smokers and those who are not able to tolerate general anesthesia are not good candidates for DIEP flap reconstruction.



Can I have DIEP flap reconstruction immediately after my mastectomy?

Immediate reconstruction is an excellent option for many women. However, if you need radiation after your mastectomy, then it’s best to delay the DIEP flap reconstruction until the radiation treatment is complete.



Will my insurance cover DIEP flap reconstruction?

Since the passage of the federal Women's Health and Cancer Rights Act of 1998, insurance companies have been required to cover breast reconstruction if they cover mastectomies. In addition, many state legislatures have passed laws that clarify what must be covered within their particular states; you can read brief summaries of the laws in New York and New Jersey (as well as other states) here.

In general, when insurance covers breast reconstruction, it must cover all types, including DIEP flap surgery. A patient and her physician must decide together what the best option is; however, many insurance carriers are not as familiar with DIEP flap surgery and may require extra information and pre-authorization steps.

Even if you have an HMO (no out-of-network benefits), you may still be able to see a DIEP flap surgeon of your choice, because there are few experienced microsurgeons that perform DIEP flap reconstruction - and since patients have a right to this type of reconstruction, HMOs often must look outside of their network for qualified surgeons.

Our office is experienced in helping patients navigate insurance issues, so please call if you have any concerns or questions.

Dr. Redstone is the founder of the Microsurgical Breast Reconstruction Program at St. Barnabas Medical Center and has offices in West Orange, New Jersey and in New York City. For more information on DIEP flap reconstruction, as well as other reconstructive procedures, please call us at 212.249.1500 (New York) or 973.867.8388 (New Jersey).



I don't live near a DIEP flap surgeon - can I have this surgery in New York City?
While DIEP flap surgery is rapidly gaining national attention for its superior results, the fact is that the number of surgeons who have the specialized training to perform the surgery has not kept pace with the number of women seeking it. Most microsurgeons are located near major metropolitan areas or destination medical centers, which means that many women must travel in order to truly consider DIEP flap surgery as an option for reconstruction.
 
Dr. Redstone operates both in New York City and in New Jersey; he and his staff are experienced in managing the complex issues that surround breast reconstruction. Dr. Redstone is passionate about ensuring the availability of DIEP flap surgery for all women who want it and are good candidates, and this often means seeing women who live outside of the New York metro area. 
 
From navigating insurance coverage to finding hotel rooms to arranging follow-up care, our office can make the process of traveling for your surgery a little less stressful. To discuss traveling to New York City for DIEP flap surgery, please call Dr. Redstone's New York office at 212.249.1500. To discuss traveling to eastern New Jersey, please call the New Jersey office at 973.867.8388.



 
I have a C-section scar – can I still have DIEP flap surgery?

If you have had lymph nodes under your arm removed as part of treatment for breast cancer, you may experience a very common side effect -- chronic swelling and pain in the arm next to the affected breast, known as lymphedema. While many women obtain relief through intense physical therapy or lymphatic massage, there are some cases that stubbornly resist all types of traditional non-surgical treatment.



Is there help for chronic lymphedema after breast cancer?

If you have had lymph nodes under your arm removed as part of treatment for breast cancer, you may experience a very common side effect -- chronic swelling and pain in the arm next to the affected breast, known as lymphedema. While many women obtain relief through intense physical therapy or lymphatic massage, there are some cases that stubbornly resist all types of traditional non-surgical treatment.

A relatively new surgical treatment, known as autologous vascularized lymph node transfer, has made its way from France, where it was pioneered, to the United States, where it is performed by a select group of microsurgeons -- the same surgeons that perform DIEP flap reconstruction and other microsurgical reconstruction procedures. This is because lymph node transfer involves some of the same techniques -- healthily lymph nodes are harvested from a woman's lower abdomen and are re-implanted in the affected area, where they are re-attached to tiny blood vessels, with the hope that they will thrive there and take over the job of filtering and draining the lymphatic system in the arm.

An article appearing last summer in the New York Times gives an intersesting overview of lymph node transfer; two of the surgeons mentioned in the article, Dr. Constance Chen and Dr. Joshua Levine, are colleagues of Dr. Redstone, with whom he operates frequently.

For questions about lymph node transfer, DIEP flap surgery, or other reconstructive procedures, please call Dr. Redstone's offices at 212.249.1500 (New York) or 973.867.8388 (New Jersey).



I had implants after surgery - can I now have DIEP flap reconstruction?

The most common reconstruction choice after mastectomy is the insertion of skin expanders and eventually implants, which can be very successful for many women. However, you may end up having to revise your implant surgery for a number of reasons: you may experience capsular contracture, an implant may rupture, the skin around the implant may begin to sag and stretch over time, or there may be an infection that requires removal of the implant. You may also decide that you prefer to have a breast reconstructed from you own tissue rather than from an implant to avoid complications associated with a prosthetic device.

What many women do not know is that even if your initial breast reconstruction was implant-based, DIEP flap reconstruction may still be an option when the need for a revision arises. If you are healthy enough to tolerate general anesthesia, a non-smoker and of normal to above-normal weight, you may be a candidate for DIEP flap reconstruction, which utilizes your own skin, tissue and small vessels (taken from the abdomen) to create a new breast.

The decision to have breast reconstruction after mastectomy is an important one; every woman should consult her own physician and surgeon to determine the best course of action.

For more information on DIEP flap reconstruction as a revision after previous breast reconstruction, please contact the Redstone MD staff at 212.249.1500 or 973.867.8388. Dr. Redstone has offices in New York City and in West Orange, New Jersey.



Why is Dr. Redstone qualified to perform DIEP flap surgery?

Dr. Redstone is a board-certified plastic surgeon with special training in microsurgery, and is the founder of the Microsurgical Breast Reconstruction Program at St. Barnabas Medical Center in Livingston, New Jersey. He has made microsurgical breast reconstruction a focus of his practice. He also operates at hospitals in New York City and has offices in both New York and New Jersey.