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why the rib is removed during diep flap

Dr. Ochoa Explains Why a Small Portion of Rib is Removed During the DIEP Flap

Comparison of Abdominal Recovery After SIEA, DIEP, TRAM Flap Breast Reconstruction PRMA Plastic Surgery

Author: Dr. Oscar Ochoa

Why is a portion of rib removed during DIEP flap breast reconstruction? 

The reason why a small portion of the rib is removed (1-2 centimeters) where it meets the sternum is because we need to get access to the blood vessels that will be providing blood flow to the tissue that is moved over from the abdomen to the chest. Removing this small portion of rib allows good exposure to the blood vessels which are very small and very delicate. There are some surgeons that do this procedure by going between the ribs instead of removing a portion of the rib. The problem with that is that it can potentially injure the blood vessels because of the limited exposure and it makes the connections of the blood vessels much more significant—adding more time to the surgery.

The removal of the rib does not hinder the mechanics of the lungs so a woman would not experience any problems breathing after surgery. There is sometimes some pain that lingers in that area for a few weeks after surgery. Ultimately that pain resolves completely and the woman never really has any long term complications from the removal of that small portion of rib.

Hope this helps!

A small portion of the rib is removed (1-2 centimeters) where it meets the sternum during a DIEP flap because we need to get access to the blood vessels.

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17 Comment

  1. Elena

    Hi Dr. Ochoa, I have a newly diagnosed breast Ca (infiltrating lacunar) of right breast. I sent my data last week & would like to expedite my treatment. I’ve been communicating with Courtney which is difficult at times due to the time difference and my schedule. How much do you think it would cost us if I choose DIEP (if appropriate) if Kaiser will not cover the treatment? Which rib is involved? Thank you for your time. Aloha, Elen

    1. PRMA Plastic Surgery

      Thank you Elena for your question! We use the cartilage closest to your sternum (located by the third rib). For coverage options, we are contracted with most major insurance companies. An exact amount for the surgery varies per patient and would be determined after your insurance benefits are verified.

  2. Debbie

    On 4/9/13 I had a tram flap which left me disabled. The incision wasn’t closed for 7 months. It was packed 2 times a day and I had the vac on it. Is there anything can be done for the constant swelling & will I ever regain feeling other than pain in my abdomen? Also my breast is back to original size before surgery. Is this normal?

  3. Ramona

    Will removal of a small portion of the rib cartilage result in a contour deformity of the sternum and, if so, how is this fixed? I am post free tram and they removed rib

    1. PRMA Plastic Surgery

      Hello Ramona! Removing the small portion of the rib cartilage does not result in any deformity

  4. Stephanie

    I had the DIEP Flap surgery done some years ago and have been very unhappy with the obvious contour deformity I had been left with. Is there any way to fix this or to at least make it look more symmetrical to the other side? Your response would be greatly appreciated. Thank you.

    1. PRMA Plastic Surgery

      Hey Stephanie! Thanks for reaching out to PRMA. Revision surgery can be performed to help correct any deformities you may have concerns about. If you would like, you can fill out our virtual consultation form at https://prma-enhance.com/schedule-your-consultation/ and one of our board-certified surgeons can evaluated your needs and provide you with their recommendations. Let me know if you have any questions!

  5. Ramona

    I am 5 months post diep which was done in Philadelphia. They removed rib on one side and I do have a LARGE concave area where the rib was removed. I have sent photos and am hoping Dr. C, or someone in the practice, can fix this with fat grafting, or something. It looks awful.

    1. PRMA Plastic Surgery

      I am so sorry to hear this Ramona. Our office did receive your photos and our patient liaison Haylie should be in touch with you to get more information and let you know how we can proceed.

  6. Susie

    I had a DIEP flap bilaterally on 6/6/16 and still have a lot of pain in sternum. I was radiated there in 2007 from first BC diagnosis. Will this make the pain recovery longer? Also am experiencing occasional involuntary gasps (not all the time but several times a day), like you do after you cry heavily. Any information as to what this could be about? Thanks!

    1. PRMA Plastic Surgery

      Hello Susie! I am so sorry to hear you are experiencing this pain. It is hard to say what could be causing it or the involuntary gasps. It is extremely important that you inform the surgeon who performed your surgery as soon as possible so he/she can rule out any complications. Also, they may be able to prescribe you different pain medications to help control your discomfort.

  7. Erica Dezaiffe

    Hello,

    I had my Dieflap surgery October 2014 and my rib cage protrudes out which makes me look pregnant. Have you encountered this with other patients

    1. PRMA Plastic Surgery

      Hello Erica. There is nothing performed during the DIEP flap that would cause the rib cage to “protrude.” However, a muscle without a healthy nerve supply will lose it’s tone, strength and function. If the DIEP surgeon does not take great care to identify and preserve the majority of the nerves supplying the abdominal muscle then the benefits of the DIEP flap procedure are potentially lost, and the risk of abdominal complications, especially an unsightly bulge, increases.

      You can learn more about this at https://prma-enhance.com/breast-reconstruction-blog/avoiding-denervation-of-abdominal-muscles-during-diep-flap/

      At PRMA, we take extra care to ensure we identify and save all necessary abdominal nerves.

  8. Marie Farrell

    Hi. I had part of the rib removed in my DIEP flap surgery in December. Is it typical to remove part of the rib on both sides? Which rib is the typical one removed? I’m unclear if my rib is now floating there. I’m also still having pain almost two months later. I’ll be needing revision on my breasts. If my current plastic surgeon can’t do what I need can I talk to someone at your office?

    1. PRMA Plastic Surgery

      Thanks for reaching our Marie. The rib itself is actually not removed. It’s a small portion of the rib cartilage that is removed so the surgeon can access the blood vessels. Patients typically do not feel any pain in the rib area following surgery, but can experience some mild discomfort for a few weeks after surgery. Rest assured, all of your ribs should still be in tact and not floating around or missing. Hope you have a lovely day!

  9. Debi

    Hi. I had my DIEP done in 2017. This is actually the first I’ve ever heard of a rib being cut and I’m curious if this could be why I’ve had horrible pain in my sternum ever since?
    I’ve had bone scans, CTs, MRIs through the years to r/o bone mets.
    But my sternum continues to have pain +2 all day long and pain +5 when touched.

    1. PRMA Plastic Surgery

      Thanks for reaching out Debi. We are so sorry to hear you are experiencing this. It would be extremely rare for you to be experiencing this level of sternum discomfort this far out from your surgery. We would highly recommend consulting with your surgeon for proper evaluation.

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