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Complications or return to theater lengthen the stay."},"diagnostic_duration_minutes":null,"diagnostic_preparation":null,"diagnostic_referral_needed":null,"diagnostic_result_time_hours":null,"exercise_resume_weeks":{"min":6,"max":12,"unit":"weeks","qualifier":"Strenuous exercise, core loading and heavy lifting after surgeon clearance and stable healing; walking starts within days."},"final_result_months":{"min":6,"max":12,"unit":"months","qualifier":"Swelling settles and the breast softens; scars mature longer. Optional refinements extend this."},"fly_home_after_days":{"min":10,"max":21,"unit":"days","qualifier":"Once discharged, mobile, drains removed or managed, no flap concerns and team clears travel; take VTE precautions."},"follow_up_visits":[{"purpose":"wound_check","requirement":"routine","after":{"min":5,"max":10,"unit":"days","qualifier":"After Hospital discharge: First outpatient wound and flap check; drains reviewed if still in place."}},{"purpose":"other","requirement":"conditional","after":{"min":10,"max":21,"unit":"days","qualifier":"After DIEP flap surgery: Drain removal review once output criteria are met."}},{"purpose":"assessment","requirement":"routine","after":{"min":42,"max":84,"unit":"days","qualifier":"After DIEP flap surgery: Healing and activity clearance review."}},{"purpose":"result_review","requirement":"routine","after":{"min":180,"max":365,"unit":"days","qualifier":"After DIEP flap surgery: Result review and discussion of optional refinement."}}],"indications":["Breast absence after mastectomy for breast cancer, immediate or delayed","Breast deformity after lumpectomy or radiotherapy","Risk-reducing mastectomy in high-risk patients (e.g., BRCA mutation)","Prior or planned radiotherapy, where implants are less suitable","Inadequate skin envelope for implants, with adequate abdominal tissue"],"main_risks":["Flap thrombosis or vascular compromise; flap loss uncommon (about 1–3%)","Fat necrosis or partial flap necrosis","Hematoma, seroma, infection, or delayed healing","Abdominal wall weakness, bulge, hernia, or numbness","Mastectomy skin necrosis and altered breast sensation","Asymmetry or contour irregularity needing revision","Venous thromboembolism and anesthesia complications","Long surgery, blood loss, and transfusion"],"pain":"Moderate to significant pain in the first days, mainly at the abdominal donor site, controlled with multimodal analgesia. Discomfort and tightness usually ease over several weeks. Numbness or altered sensation may persist.","preparation":["Oncologic and plastic surgery planning, including timing","Medical assessment, blood tests, and anesthesia review","CT or MR angiography to map abdominal perforators","Stop smoking and nicotine for weeks before and after","Review medications and supplements, including blood thinners","Fasting before general anesthesia","Pre-operative marking and photographs","Arrange home help and nearby lodging after discharge"],"recovery_timeline":[{"phase":"Hospital stay (about 3-6 nights)","description":"Flap monitoring, drain care, pain control, VTE prevention, and early mobilization with sitting and short walks.","restrictions":["No driving","Avoid pressure or tension on flap and abdomen","Nicotine avoidance continues"]},{"phase":"Weeks 1-6","description":"Home recovery with drains managed until removal, gradual walking, and a flexed-hip posture easing as the abdomen heals.","restrictions":["No heavy lifting","No strenuous or core exercise","Wear supportive garments"]},{"phase":"Weeks 6-12","description":"Ordinary function and desk work fully resume; physical work and exercise return stepwise after clearance.","restrictions":["Heavy lifting and high-impact sport only after surgeon clearance"]},{"phase":"Months 6-12","description":"Swelling resolves, the breast softens, and scars mature; optional refinement can be planned.","restrictions":[]},{"phase":"At any time","description":"Seek urgent care for flap color change or coolness, sudden swelling, fever, wound discharge, chest pain, breathlessness, calf swelling, or severe abdominal pain.","restrictions":[]}],"rehabilitation_days":{"min":28,"max":84,"unit":"days","qualifier":"Ordinary daily function returns after uncomplicated unilateral DIEP; slower with complications or adjuvant therapy."},"result_longevity":"The reconstructed breast is made of the patient's own tissue and is generally long-lasting, changing with weight and aging. Fat necrosis or contour changes may occasionally need revision.","revision_rate_pct":{"min":20,"max":50,"unit":"percent","qualifier":"Later contour, fat grafting, or nipple-related revisions within 1-2 years after unilateral DIEP; many are elective."},"scars":"Breast scar (mastectomy scar or new incision if delayed), a long low horizontal abdominal scar, and a scar around the navel. Small drain marks; scars mature over 12 months or longer.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"One primary DIEP free-flap operation with a single hospital admission."},"stages":[{"code":"planning_imaging","label":"Surgical planning and perforator imaging","after":{"min":0,"max":30,"unit":"days","qualifier":"After First consultation: Planning and imaging are scheduled before surgery, counted from the first consultation; timing depends on cancer treatment."}},{"code":"inpatient_monitoring","label":"Inpatient flap monitoring, drain care, and mobilization","after":{"min":0,"max":6,"unit":"days","qualifier":"After DIEP flap surgery: Uncomplicated stay; flap checks continue until discharge."}},{"code":"optional_refinement","label":"Optional contour or nipple-areola refinement","after":{"min":90,"max":180,"unit":"days","qualifier":"After DIEP flap surgery: Conditional, not mandatory; timing depends on healing, swelling, and any adjuvant therapy."}}],"qualifier":"Primary numbers cover only the single DIEP operation. Later refinements are optional, and implant-based reconstruction is outside this profile."},"success":{"metric":"Early flap survival without total flap loss","value":97,"unit":"percent","horizon":"During the initial hospital stay and first weeks","population":"Adults after unilateral DIEP free-flap breast reconstruction in specialist microsurgical centers","evidence_status":"limited"},"techniques":[{"name":"Unilateral DIEP free-flap breast reconstruction (primary profile)","suits_whom":"Patients with enough lower abdominal tissue and suitable perforator vessels who want autologous reconstruction after mastectomy.","recovery":"Several inpatient nights with flap monitoring; ordinary functional recovery takes several weeks."},{"name":"Alternative: implant or tissue expander-based reconstruction (outside primary numbers)","suits_whom":"Patients with adequate skin envelope who prefer a shorter operation or no donor site.","recovery":"Shorter initial stay; may need expansion visits and later implant exchange."},{"name":"Alternative: other flaps (e.g., muscle-sparing TRAM, latissimus dorsi, thigh flaps) (outside primary numbers)","suits_whom":"Patients unsuitable for DIEP because of insufficient abdominal tissue or vessel anatomy.","recovery":"Varies by flap and donor site."},{"name":"Optional nipple-areola reconstruction and contour refinement (outside primary numbers)","suits_whom":"Patients who have healed after breast mound reconstruction and want nipple restoration or symmetry adjustment.","recovery":"Usually short procedures, often day-case; recovery is shorter than for the primary operation."}],"treatment_conditions":["inpatient"],"treatment_duration_hours":{"min":4,"max":8,"unit":"hours","qualifier":"Operating time for uncomplicated unilateral DIEP with microvascular anastomosis; longer if combined with mastectomy or complicated by vessel problems."},"initial_assessment_documents":["Front, side and back photos of torso","Mastectomy operative and pathology reports","Oncology treatment summary with radiotherapy dates","Abdominal CT or MR angiography (if available)","Previous abdominal surgery history and scars"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Single DIEP operation; about 2-3 weeks total for stay, drains and travel clearance. Follow-ups can be done at home."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Ask how many reconstructive breast surgeries the surgeon has performed","scope":"procedure","source":{"url":"https://www.theaestheticsociety.org/procedures/breast/breast-reconstruction/selecting-surgeon","host":"theaestheticsociety.org","quote":"How many reconstructive breast surgeries have you performed?","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"C2","text":"Ask whether the surgeon has before and after photos of breast reconstruction procedures you can see","scope":"procedure","source":{"url":"https://www.theaestheticsociety.org/procedures/breast/breast-reconstruction/selecting-surgeon","host":"theaestheticsociety.org","quote":"Do you have before and after photos of breast reconstruction procedures that I can see?","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"C3","text":"Check that you have two consultations with the treating surgeon before any surgery","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery-abroad/","host":"nhs.uk","quote":"You should have 2 consultations with the surgeon treating you before any surgery.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"C4","text":"Check how your aftercare will be coordinated before you agree to treatment","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Ensure you're clear about how your aftercare will be coordinated.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"C5","text":"Check that you understand the possible complications and side effects of the treatment","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Make sure you understand the possible complications and side effects that could arise from your treatment.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"Cut-price campaigns or cheap offers for surgery are a warning sign","scope":"treatment_type","source":{"url":"https://bapras.org.uk/media-government/news-and-views/view/cut-it-out-surgery-societies-and-britain's-largest-surgical-royal-college-slam-summer-discounts","host":"bapras.org.uk","quote":"Surgery should never be subject to cut price campaigns or cheap offers, it is too important.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"F2","text":"A consultation only with sales 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doctor information about your treatment and future care needs","document":"discharge letter for gp","source":{"url":"https://www.nhs.uk/nhs-services/hospitals/going-into-hospital/being-discharged-from-hospital","host":"nhs.uk","quote":"You'll also be given a letter for your GP, providing information about your treatment and future care needs.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"T2","text":"Ask for written details of the procedure before you leave the hospital","document":"written procedure details","source":{"url":"https://rcseng.ac.uk/patient-care/cosmetic-surgery/after-surgery/","host":"rcseng.ac.uk","quote":"After your surgery, before you leave the hospital, ask for written information about the procedure you've had.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T3","text":"Ask for copies of all prescriptions before you leave","document":"prescription copies","source":{"url":"https://travelhealthpro.org.uk/news/699/travelling-abroad-for-treatment","host":"travelhealthpro.org.uk","quote":"Remember to ask for copies of all your treatment records, including prescriptions, scans and x-rays before you leave.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T4","text":"Home doctor needs the dates for required blood tests and follow-up appointments","document":"written aftercare plan","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"This should include any medication and doses, as well as any dates that blood tests and follow-up appointments must be carried out.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T5","text":"Lets a doctor at home identify the breast implants you received","document":"implant registration card","source":{"url":"https://www.canada.ca/en/health-canada/services/drugs-medical-devices/breast-implants/what-to-know.html","host":"canada.ca","quote":"You should also receive a product registration card from your surgeon with information about the implant or implants.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"alternatives":{"status":"ok","items":[{"id":"A1","text":"You would rather not have reconstruction surgery after mastectomy","name":"Breast prosthesis","source":{"url":"https://my.clevelandclinic.org/health/articles/breast-reconstruction","host":"my.clevelandclinic.org","quote":"Instead, they wear a breast form (prosthesis) inside a special 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