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From DIEP Flap and TUG Flap procedures to lesser-known SHAEP and Stacked Flaps, we offer a range of natural tissue reconstruction and breast sensation restoration options. Whether you're interested in direct-to-implant or expander implant reconstruction, we are experienced in both prepectoral and subpectoral approaches. We perform a wide range of procedures, like conversion to prepectoral implants, flap revision, fat grafting, and surgery on the opposite breast, to improve your breast reconstruction. We offer surgical and non-surgical options, like 3-D tattoo, that allow our surgeons to create a natural appearing nipple as the final touch for your breast reconstruction. We help our patients understand the types of mastectomies available and how genetic information, like BRCA gene mutations, can factor into your decisions. We pioneered a unique and reliable abdominal wall reconstruction procedure to repair TRAM flap related hernias and contour deformities. We offer procedures to help prevent as well as ease lymphedema, a condition where limbs swell after lymph node removal. Radiation can be an important part of your breast cancer treatment. Learn how to coordinate it with your reconstructive timing and approach. For men facing mastectomy, we offer a variety of procedures including natural tissue flaps, fat grafting, and nipple reconstruction. Our team can help you navigate surgical options from facelift and browlift to necklift and eyelid rejuvenation. Non-surgical facial rejuvenation options include Botox, fillers, laser peels, and chemical peels. In addition to nose-reshaping, our surgeons perform procedures that can alleviate breathing difficulties associated with deviated septum and internal nasal blockages. We’re experts in cosmetic breast procedures, including augmentation with fat grafting, implant augmentation, reduction, and lift. Liposuction, abdominoplasty, or tummy tuck, and butt augmentation can all reshape the body to improve your appearance. We offer brachioplasty, or arm lift, and thigh lift to transform your extremities. Enjoy body sculpting and facial rejuvenation treatments like CoolSculpting, IPL, Microneedle Skin Tightening, and more administered by our Aesthetician. Oncoplastic procedures like oncoplastic closure, reduction and lift, and local tissue flaps for volume loss preserve breast shape after a lumpectomy. A systematic approach to post mastectomy pain. Specialized tattooing and micro-needling can help create or refine nipple reconstruction, manage scars, and more. Tattooing can create permanent makeup, improve the appearance of hair density, and more.
Home > Breast Reconstruction > Natural-tissue Flap Reconstruction > SHAEP Flap Breast Reconstruction

Summary

While a DIEP flap uses the front of the abdomen to provide sufficient volume for breast reconstruction in most women, the SHAEP flap is an excellent option for thin women with fuller breasts. When DIEP flaps alone do not provide sufficient tissue for the reconstruction of both breasts, additional tissue from the “love handle” area on each side can extend the amount of tissue available.

Since the blood supply to the lower abdominal and hip tissue can vary, a preoperative CT angiogram can help identify the perforator blood vessels that are best in any given patient. This can help with surgical planning and can determine how the SHAEP flap will be done.

Types of procedures

  • DIEP flap and DCIA flap: The deep circumflex iliac artery (DCIA) provides blood supply to the hip area and is most commonly used in addition to the DIEP flap.
  • DIEP flap and SIEA flap: The superficial inferior epigastric artery (SIEA) may also provide blood supply to the hip area and can be used in addition to the DIEP flap.
  • DIEP flap and SCIA flap: Alternatively the superficial circumflex iliac artery (SCIA) provides blood supply to the hip area and is used in addition to the DIEP flap.

Procedure details

  • CT angiogram before surgery identifies the blood supply
  • The surgeon elevates a flap of skin and fat from the front of the abdomen and from the adjacent hips
  • Careful microsurgical technique allows exposure of the perforator vessels that feed into the overlying flaps
  • The flaps are transferred to the mastectomy defect with the tissue from each side of the abdomen and from each hip being used for each breast
  • Blood vessels from the flaps are connected to blood vessels in the chest using the operating microscope
  • Having two stacked flaps for each reconstructed breast allows for an adequate volume and shape even in thin patients
  • After flap transfer, any incisions in the abdomen and lower waist are closed, much like an extended tummy tuck

Risks & Benefits

As with any free flap breast reconstruction procedure, the SHAEP flap carries a small risk of failure if there is disruption of blood flow to the flap after surgery. This risk depends in part on the level of experience of the plastic surgeon. The surgeons at NYBRA Plastic Surgery are experts in advanced microvascular breast reconstruction and routinely perform such reconstructions with a success rate of greater than 99%.

Since tissue from each “love-handle” area is used along with the front of the abdomen, the SHAEP flap often results in a favorable contour with an improved waist line.

Frequently Asked Questions

If the SHAEP flap involves two flaps for each breast, will my recovery be more difficult?

Since all the tissue is taken from the abdomen, the recovery time for the SHAEP flap is similar to the recovery following DIEP flap breast reconstruction. Compared to the DIEP flap the abdominal scar extends further to the sides.

Before & After Gallery
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Case 13 after photo Breast Reconstruction DIEP Flap Case 13 Before photo: Breast Reconstruction DIEP Flap
Color photo of chest area: Breast Reconstruction DIEP Flap Color photo of chest area: Breast Reconstruction DIEP Flap
Case 18 Breast Reconstruction DIEP Flap Before photo of chest area: Breast Reconstruction DIEP Flap
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