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Microsurgery and DIEP Flaps at Multiple Sites

At Midwest Breast and Aesthetic Surgery, we are pleased to offer advanced breast reconstruction options, including DIEP flap and GAP flap techniques, at several locations across Ohio. One of our main goals is to keep advanced care close to home.


Several developments have made it possible for us to bring advanced microsurgical reconstruction to locations that keep patients close to home and focus on providing personalized care in warm, easy-to-access facilities.


One of the greatest advances has been the evolution of the operation itself. Traditionally, breast reconstruction using tissue from the lower part of the abdomen relied on the six-pack muscle to maintain blood flow to the tissue after it was rotated to the chest to reconstruct the breast. This operation is known as the pedicled-TRAM procedure. It gained wide-spread use because it did not require additional microsurgical skills and equipment such as a surgical microscope.


The advent of microsurgery and an improved understanding of which blood vessels supply blood to the skin and fat fostered the advent of breast reconstruction using free DIEP flaps. The DIEP flap is based on small vessels that travel through the six-pack muscles, so it does not require this core muscle to be sacrificed. The DIEP flap also utilizes microsurgical techniques to literally transplant the skin and fat (no muscle) from the lower abdomen to the chest. This means that an artery and a vein are connected under a surgical microscope, using stitches that are barely visible to the naked eye.


ViOptix Monitor for flap monitoring.

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Tissues that are moved using microsurgical techniques rely on blood to flow through these small blood vessels after they are reconnected under the microscope. They are monitored very closely the first few days after surgery to make sure the blood is flowing in and out of the tissues. In the past, this process of “flap monitoring” was thought to require specialized personnel and frequent checks of the tissue. Several technologies have been developed which have made this process more reliable and less labor-intensive. For example, the T.Ox Tissue Oximeter (ViOptix, Fremont, CA) is a non-invasive monitor that can send a continuous readout of the oxygen level in the flap tissue directly to the surgeon’s smart phone or computer. This allows for continuous monitoring by the physician and reduces the need for highly specialized intensive care units and nursing.


So thanks to several advances, we are able to utilize advanced microsurgical skills to perform DIEP and other perforator free flap operations at several locations to reach patients throughout the Midwest.

About the Author

Ergun Kocak

Dr. Ergun Kocak, MD, MS, is a board-certified plastic surgeon who specializes in plastic and reconstructive surgery of the breast using DIEP, SIEA GAP, TUG, PAP, and direct-to-implant, in Columbus and Cincinnati, OH.
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Copyright 2014 Midwest Breast & Aesthetic Surgery. Dr. Ergun Kocak*, Dr. Pankaj Tiwari*, Dr. Ayaz Shaikh*, Dr. Shunsuke Yoshida. All Rights Reserved. | Disclaimer
*All doctors are certified by the ASPS, ABPS & ASRM.
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