Whilst the DIEP flap would generally be acknowledged as the gold standard in autologous breast reconstruction, there are times when it is exactly the wrong thing to do. Recently, at the London Breast Meeting several sessions really highlighted for me the problem with surgeons doing the operation they want to do, rather than the operation that the patient needs. This isn’t to say that these surgeons don’t have their patient’s best interests at heart. The problem is one of not seeing the forest for the trees.
A DIEP flap is 4 hours of my time in an operating theatre. But that same DIEP flap is a week in hospital for a patient. It is sleepless nights whilst nurses are constantly checking and rechecking to be sure that there is no problem with the blood supply to the flap: every hour for the first day, every 2nd hour for the second day and so on. It may be a painful abdomen. It is a gradual recovery over about 6-12 weeks. It can be not being able to pick up their children during their recovery. It is a donor site which results in a scar from hip to hip. Rather than a flat stomach afterwards (as most patients think they will have) there may be “dog-ears” or a stretched, hypertrophic scar.
“A DIEP flap is 4 hours of my time….But that same DIEP flap is a week in hospital for a patient….and a gradual recovery over 6-12 weeks”
I paint this picture not to discourage patients from having a DIEP flap reconstruction. On the contrary, I perform these operations precisely because I believe that it is an excellent reconstruction.
BUT (and there is always a but) this operation (just like every operation if we’re honest) is only the right operation if it is done on the right patient. Just because I can do it, doesn’t mean that I will. For every patient, there is one operation that is best suited to them. And that may not be the operation that, in ideal circumstances, I would want to do.