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Microsurgical Procedure Uses Fat from Abdomen (Like Tummy Tuck) to Rebuild Breast
Many women who have had a mastectomy as part of their cancer treatment feel that breast reconstruction is an important part of their healing process. And today, plastic surgeons are able to rebuild breasts that look and feel more natural.

One of the most sought-after breast reconstruction techniques is deep inferior epigastric artery perforator (DIEP) “flap” reconstruction, says Juan Carlos Martinez, MD, of St. Luke’s Plastic & Reconstructive Surgery. (The term “flap” refers to procedures that use a woman’s own tissue to restore the breast, as opposed to implants filled with saline or silicone.)

DIEP breast reconstruction rebuilds the breast lost to mastectomy by relocating fat, skin and vessels taken from another part of the patient’s body, usually the abdomen. DIEP is an advanced microsurgical procedure that uses specialized operating microscopes and precision instrumentation to perform intricate operations on tiny structures.

Because the procedure can take many hours, women considering breast reconstruction, should look for plastic and reconstructive surgeons who offer a team approach, says Dr. Martinez, who can perform the procedure with his colleague Lino Miele, MD, also a microsurgeon with St. Luke’s Plastic & Reconstructive Surgery.

With the two-surgeon team approach, the procedure time is shorter as is the length of stay,” Dr. Miele says. “These procedures can take many hours when performed by a single surgery. With two surgeons, we can reduce this time by 30-50 percent.”

Among its advantages, DIEP doesn’t require maintenance or repeat surgery, which often occurs with breast implants over time, he explains.
“To ensure that the tissue will survive in its new location, we reattach the blood vessels in the tissue to blood vessels in the chest and carefully reshape the patient’s skin and fat tissue into a breast mound that is then sutured into place,” Dr. Miele says. “Because the breast is made from the woman’s own tissue, it has a natural look and feel that lasts a lifetime.”

For women considering breast reconstruction, however, there are basically three options:
Natural tissue flaps, such as DIEP. Some flap methods also involve muscle taken from the woman’s body
Breast implants filled with either saline or silicone
A combination of these methods
“We recommend that every woman who has had or will have a mastectomy consider having a consultation with a plastic surgeon,” Dr. Martinez, says. During the consult, we will explain the options so the patient can make an informed decision.”
Dr. Miele adds that several factors must be taken into account such as the woman’s desire for reconstruction, her age, general health and cancer treatment needed.
“There are no right or wrong decisions,” he says. “What matters most is that the woman decides what option will help her heal physically and emotionally.”

About Drs. Miele and Martinez
Dr. Miele received training in the DIEP procedure at the University of Pittsburgh Medical Center, where he received extensive experience with microsurgery procedures. He received additional experience through a National Institutes of Health (NIH) sponsored postdoctoral research fellowship at Harvard Medical School, where he investigated microcirculatory blood flow and tissue regeneration. Dr. Miele completed his residency training at Lankenau Medical Center in Wynnewood, PA. He is certified by the American Board of Surgery with expertise in the reconstructive surgical management of cancer and traumatic injury.
Dr. Martinez joined St. Luke’s Plastic & Reconstructive Surgery in September after completing a microsurgery fellowship at the Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, OH. Dr. Martinez completed his residency at St. Luke’s University Health Network, where he was the chief surgical resident. Previously, he completed an internship at Mount Sinai School of Medicine in New York. He is certified by the American Board of Surgery.