Many thin women are told they are not candidates for traditional autologous (flap) breast reconstruction. The "stacked flap" approach allows many of these women to use their own tissue to reconstruct their breast(s) without an implant.
Reconstructing One Breast
In thin women all the lower abdominal tissue may be needed to reconstruct one breast. This can be to transplanted to the chest as two separate DIEP flaps, each with its own blood supply. The flaps are then "sandwiched" or placed next to each other in the chest and reconnected using microsurgery to create a "natural" breast with an aesthetic size and shape. This technique is known as the "stacked DIEP flap" procedure.
This approach can be used with essentially any flaps, not just the DIEP flap. Thigh flaps are also often stacked.
A symmetry procedure for the other breast (eg lift or reduction) may be needed to match the breasts as closely as possible. This can be performed at the same time as the initial reconstruction or as part of a subsequent "revision" surgery.
Reconstructing Both Breasts
In these cases, each breast is usually reconstructed by "stacking" flaps from different parts of the body.
Whether one or both breasts are being reconstructed, the stacking principle using 2 flaps for each breast can be applied to any flap combination depending on the patient's tissue distribution and available flap options. While the DIEP flap is used the most frequently as part of a stacked pair, any two flaps can be stacked.
The best cosmetic results are achieved when the reconstruction is performed at the same time as the mastectomy, preferably a skin- or nipple-sparing mastectomy in appropriate candidates.
Microsurgical breast reconstruction procedures like the stacked DIEP flap are not offered routinely by all plastic surgeons due the complexity of the surgery and the need for additional training. Using multiple donor sites in one surgery can prolong the total surgical time significantly and increases the risk of complications. This must be carefully considered and fully discussed during the decision-making process.
Bilateral stacked or combination flaps should only be performed in very select situations and by extremely experienced microsurgical teams. Unfortunately, many patients seeking one of these breast reconstruction options may need to travel to specialized centers for their surgery.
Content provided by PRMA Plastic Surgery | Center for Advanced Breast Reconstruction