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The APEX Flap: A New Approach to DIEP Reconstruction

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The photographs included on this page are the results of reconstructive procedures performed by the surgeons at the Center for Restorative Breast Surgery.

One of the biggest concerns with flap reconstruction is making sure that the tissue has a strong blood supply after it is moved to the chest area. Sometimes, the blood vessels in a DIEP flap are not located in a single line in the rectus abdominis muscle (the lower abdomen). As a result, the surgeon may have to decide between cutting muscle between the vessels to bring them together or leaving the flap with less blood flow. If muscle is cut through to improve the blood flow in the flap, the DIEP flap is no longer a completely “muscle-sparing/muscle-preserving” surgery, and recovery can be more difficult. Ideally, all muscle should remain intact to preserve the strength of the abdominal wall and minimize any long-term impact on your ability to do your normal activities.

Surgeons at the Center for Restorative Breast Surgery in New Orleans have pioneered a new approach, called the APEX FlapCM, (Abdominal Perforator Engineered vascular eXchange Flap), which minimizes impact on the lower abdominal muscle. The APEX FlapCM also allows for an unlimited increase in blood flow to the new flap. In this new approach, if there is a risk for destroying muscle in order to achieve blood flow, the surgeons visually examine the patient’s natural blood vessel anatomy and re-engineer its design. This allows surgeons to create a soft, living breast while simultaneously preserving the abdominal muscle in its original condition. The blood vessels are rearranged within the flap itself to add proper blood flow. This helps to ensure that the tissue is well-nourished, maintains its volume, and remains soft and healthy after it is moved. This also helps reduce the risk of partial flap failure (tissue breakdown due to inadequate blood supply) and fat necrosis (fat tissue turning into scar tissue, also due to poor blood supply). At the same time, the surgeon can avoid damage to the muscle that lies around and between the blood vessels that feed the flap.

apex flap
APEX FlapCM Reconstruction -- Before and After

Although this DIEP technique isn’t widely available, it may become more available in the near future. In the meantime, if you are having a DIEP flap reconstruction, you can ask your surgeon about any possibility that he or she would need to cut into the lower abdominal muscle. Again, it’s best if your surgeon can avoid cutting the muscle while also making sure there are enough blood vessels to feed the flap after it is moved and formed into your new breast.

The photographs on this page are copyrighted materials and no reproduction or use of these photographs is permitted except with the written consent of the Center for Restorative Breast Surgery.


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