Natural Breast Augmentation (cosmetic DIEP flap)

Microsurgery is a term used to when surgeons operate under a microscope. In plastic surgery it is used to stitch (sew) or repair small vessels (arteries and veins) as well as nerves.

It has many applications in plastic and reconstructive surgery but traditionally is most commonly used in the following clinical areas;

1.     Breast Reconstruction – reconstruction of the breasts after cancer (mastectomy).

2.     Head and neck reconstruction – reconstruction of the head / neck and face after complex cancer excision or trauma.

3.     Hand and upper limb surgery – to repair nerves or transfer nerves for hand function or to replant (put back on) a digit or a limb after trauma.

4.     Lower limb salvage – after high energy trauma orthopaedic and plastic surgery teams work together to treat lower limb injuries. Prior to microsurgery, at lot of these patients would receive amputations. 

Fat grafting is a common and useful technique in plastic surgery. Most plastic surgeons will agree, however, that fat grafting is best used as an adjunct (addition) to other surgical procedures.

The key difference between fat grafting and a cosmetic DIEP flap is blood supply. The cosmetic DIEP flap has its own blood supply and therefore is viable (alive) whilst fat grafting does not have its own blood supply and must receive its blood supply from the breast tissue and until it does it is non viable (dead). The process in which a graft “takes” – i.e becomes viable can vary on the tissue but is 4-7 days and is very unpredictable. Furthermore, grafts that have “taken” undergo a period of resorption and at 6 months on average 50 % of the volume is lost.

Most patients who undergo fat grafting for natural breast enhancement will achieve an increase in half to one cup size at best. Often this requires multiple operations.

The most common reasons women choose to have breast implant removal surgery include:

1. Implant complications - Breast implant complications include: capsular contracture, implant rupture, folding, displacement, infection, leakage of silicone, and deflation (if the breast implant is filled with saline). 

2. Changing preferences - Many women who have had breast implants when they were younger may later make the decision to have them removed. The reasons for doing so can include changes in personal preferences, beauty ideals or lifestyle changes.

3. BIA – ALCL - Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare form of non-Hodgkin’s lymphoma. The FDA wants to raise awareness of the cancer, even though it's very rare. The estimated incidence rates range from a high of 1 in 3,817 patients to a low estimate of 1 in 30,000. When diagnosed early and managed properly - it is readily curable.

4. Breast implant illness - Breast Implant Illness (BII) is a term used by women who have breast implants and who self-identify and describe a variety of symptoms including (but not limited to) fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, rash, body odour, anxiety, brain fog, sleep disturbance, depression, neurologic issues, and hormonal issues that they feel are directly connected to their saline or silicone, textured or smooth breast implants.

The cosmetic DIEP flap is a combination of multiple procedures and patients will generally fall into one of three categories

1. Post pregnancy surgery

   For many women, pregnancy and childbirth are the cornerstones of happiness. However, the resulting physical aspects can create long-lasting changes in appearance and in some instances, physical issues. Natural breast augmentation in this instance would include an abdominoplasty, breast mastopexy (lift) and natural breast augmentation.

2. Post weight loss surgery (body contouring surgery)

   After significant weight loss patients can experience unwanted excess skin around the lower abdomen and ptotic (droopy) breasts. Natural breast augmentation in this instance would include an  extended abdominoplasty, breast mastopexy (lift) and natural breast augmentation.

3. Post breast implant complications

   In this instance the procedure would included capsulectomy, removal of implants and natural breast augmentation (cosmetic DIEP flap). Dr van der Rijt understands that there are many reasons a woman may decide to have her breast implants removed, from changes in appearance and style to concerns about health. He is sensitive to the needs of each patient and he offers several methods of breast implant removal and complete removal of the capsule. This can also be combined with the cosmetic DIEP flap (natural breast augmentation) if women are looking for a natural way to restore breast volume.

Autologous or Free Flap Breast Reconstruction can have some significant complications, and you may not be a good candidate for it if you fall into the following categories:

• You are obese (BMI >35).

• You smoke.

• You have had previous clots in the legs or lungs, or carry a gene that predisposes to clotting.

• You are on blood thinners.

• You have multiple other medical problems that make you unsuitable for a long procedure.

In addition, a cosmetic DIEP flap may not be possible if:

• You are a skinny person and lack a sufficient amount of abdominal tissue to harvest for breast augmentation.

• You have previously had an abdominoplasty or DIEP flap.

• You have had an open cholecystectomy (gallbladder removal through a large incision on the tummy).

• Have had multiple abdominal procedures (liposuction is generally not a contraindication).

• Whilst planning to have kids or start a family is not a contraindication, this procedure is best done after the patient has finished having children.

Any surgery carries risks and Dr van der Rijt will discuss these in depth with you during your consultation.

Unfortunately, with anything in life and with any operation there is no 100% guarantee. Most surgeons who perform DIEP flap operations on a regular basis will quote a 1-2 % total failure rate. In the small chance the DIEP flap does not work it is usually evident before you leave hospital. After 3 -4 days once you leave hospital it is extremely unlikely you will have any issues with the DIEP flap. Unlike fat grafting, after this there is no volume loss over time.

Broadly speaking cosmetic DIEP flaps can range from 150 cc – 700 cc depending on the volume of the lower abdomen and the desired result. This is patient dependent. Volumetric analysis is performed and Dr van der Rijt can discuss this with you during your consultation.

Depending on what procedures you require, your insurance may cover a small component of the operation. As this is largely a cosmetic procedure and a procedure that takes a considerable amount of time, it will only cover a small component of the overall cost. Dr van der Rijt and his staff will give you a comprehensive  quote at the time of the first consultation.

• Anaesthetic: GA by accredited anaesthetist.

• Time: 5-7 hrs.

• Duration of stay: Requires 4-5 days of inpatient stay .

• Medicare/Health Fund Rebate: Yes, if you have appropriate level of insurance cover. Depending on the indication. This will be a small component of the total overall cost.

• Recovery: In-patient hospital stay for approximately 3 nights. Full recovery at 6 weeks. Dr van der Rijt will discuss detailed recovery during your consultation.