Breast Reconstruction & the DIEP Flap

Chapter 2 of Volume 4, Breast, Trunk, Lower Limb & Aesthetics. Revision notes and examiner-style viva questions with model answers for the FRCS (Plast).

33 viva questions in this chapter

1. Please describe this photograph.
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2. This lady has just moved into your catchment area and would like to consider her options. What is your general approach to a patient seeking delayed breast reconstruction?
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3. How would her oncological treatment affect your plan?
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4. What about predicted survival? Would that affect your plan?
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5. Why do you have a cut-off for BMI? How would you manage her if her BMI were over 30?
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6. She is unsuccessful with weight loss and is severely distressed by her mastectomy scar. What then?
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7. Take me through your assessment of the recipient site and the donor sites.
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8. Would you discount a DIEP in a patient with a previous laparotomy?
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9. You mentioned radiation damage. What is radiotherapy, and how does it work?
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10. How are the sequelae of radiotherapy reduced?
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11. What are the effects of radiation damage?
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12. Let’s reconsider this lady with a failed DIEP after radiotherapy. What will you offer her?
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13. What are the causes of free flap failure in general?
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14. You proceed with another free flap. Which recipient vessels will you use? The internal mammary vessels were used last time.
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15. Why are the internal mammary vessels your first choice?
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16. Why not use preoperative imaging to assess the recipient vessels, as you would for the perforators?
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17. Tell me about the perforating patterns of the deep inferior epigastric artery.
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18. Talk to me about the zones of perfusion.
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19. How would you approach reconstruction after breast-conserving surgery?
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20. Please describe this photograph.
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21. How does a microvascular anastomosis heal?
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22. Which factors increase the risk of anastomotic thrombosis?
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23. Do you have any contraindications to performing a microvascular procedure?
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24. Would you perform a free flap in a smoker? After irradiation? In the very elderly?
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25. How would you manage recipient vessels with severe radiation damage, if there were no alternative?
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26. What is your view on anticoagulation after the anastomosis?
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27. How do aspirin and heparin work?
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28. You are on call. Your trainee tells you the flap is blue. What do you do?
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29. How would you handle a size discrepancy between the vessels?
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30. What is a venous coupler?
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31. How would you monitor the anastomosis?
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32. The whole venous system is filled with thrombus. What now?
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33. The anastomoses are patent but the flap does not bleed. What is happening?
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