APEX FlapSM Breast Reconstruction

Apex Flap

What is APEX FlapSM Breast Reconstruction?

The APEX FlapSM breast reconstruction is a highly sophisticated microsurgical technique that is used to rebuild the breast lost to mastectomy. Like the DIEP Flap, excess living fat from below the belly button is transplanted to the chest to restore volume and shape. The APEX FlapSM differs from an ordinary DIEP however, as it allows for the natural anatomy and blood vessels to be rearranged to perfectly preserve the abdominal muscles and improve blood flow to the tissue transplant when necessary. This technique is an advancement over the DIEP procedure and has very specific indications and benefits.

The APEX FlapSM is one of the most advanced surgical technologies available in breast reconstruction. The ordinary DIEP can require muscle cutting to improve blood flow in the tissue in some situations. The APEX FlapSM was pioneered at the Center For Restorative Breast Surgery in 2012 to eliminate this problem. When required due to individual anatomy, the surgeons at The Center For Restorative Breast Surgery shift to The APEX FlapSM to prevent muscle damage and improve the quality of the operation. This assures the maximum opportunity for a successful procedure, with preserved strength and long-term softness in the new breast.

We believe so firmly in this quality measure that digital imaging is used to document the perfect preservation of the muscle wall in the tummy during our procedures. This standard of care elevation is unique to The Center for Restorative Breast Surgery and gives reassurance to our patients that extreme care has been applied to the details of their procedure to provide for their long-term well-being.

Our surgeons have presented this progressive work in medical conferences around the world and are proud to offer it as an elevation of the standard to our clientele.

When is APEX FlapSM Breast Reconstruction Used?

Our Center’s surgeons shift to the APEX FlapSM from the DIEP when the anatomy of an individual isn’t otherwise ideal to produce a quality result. The improvement in blood flow to the fatty tissue ensures better long-term softness in the newly created breast. Another important benefit of the APEX FlapSM procedure is that the muscle of the abdominal wall is fully protected and core strength is preserved in every patient. It is NEVER necessary to convert to a TRAM procedure for any reason with the APEX FlapSM advancement. This avoids the need for artificial mesh placement into the abdomen, prevents hernia formation, and guards against long-term abdominal weakness.

What are the Benefits of APEX FlapSM Breast Reconstruction?

Like the DIEP procedure, the APEX FlapSM technique affords the recreation of the breast with soft, warm, living fat that is permanent and doesn’t require maintenance over time. For women who’ve undergone  a mastectomy in the past, the APEX FlapSM procedure also allows for the avoidance of tissue expanders.

Women who undergo APEX FlapSM breast reconstruction benefit from improved abdominal shape, much like a “tummy tuck.” Using fat from unwanted areas of excess produces a flatter, tighter abdomen as a nice compliment to the newly reconstructed breast and the APEX FlapSM allows the abdominal incision to be kept lower in the bikini line than conventional DIEP procedures.

What are the Risks of APEX FlapSM Breast Reconstruction?

As with any surgery, the risks can be minimized by carefully following your pre-surgical instructions. If you have other medical problems or any factors which may increase your risk, we will work with you to educate you on proper preparation and arrange your clinical care regimen to maximize your safety and proper recovery.

What should I expect prior to my APEX FlapSM Breast Reconstruction surgery?

In most cases, you will be seen in our office 1-2 days prior to your surgery. At that time, we will go over the planned procedure, review consents, answer any questions you may have, and apply any surgical planning markings as may be required.

What should I expect on the day of my APEX FlapSM Breast Reconstruction surgery?

When you arrive at the hospital, you will be escorted to the preoperative holding area where you will change into a gown and be given foot coverings. The nurse or anesthesiologist will start an IV so that fluids and necessary medications may be given to you. Family members will be allowed to visit with you in the preoperative area once you are prepared for surgery.

After your surgery is complete, you will awaken in the recovery room under warm blankets with a dedicated nursing attendant at your side. You will be carefully monitored and kept comfortable. You will then be transferred to a private inpatient room that is prepared to allow you to rest and recover under the supervision of your attending physician and nurses. One adult caregiver may stay with you overnight during your hospitalization. A fold-out Murphy bed has been integrated into your room for their individualized comfort.

Your procedure will be performed in a state-of-the-art operating suite that is part of a fully accredited hospital that has been recognized by the American College of Surgeons for Excellence in care quality. Highly trained professionals using the most modern equipment and techniques will attend to you. In addition to your surgeons, the surgical team includes anesthesiologists, operating room technicians, nurses, and physician assistants.

What should I expect during my recovery from APEX FlapSM Breast Reconstruction Surgery?

You will experience some changes that are quite common after surgery and may include:


Some mild swelling and bruising is to be expected after surgery and will gradually subside in a few weeks.


Some soreness is normal after surgery, but we will provide medications to maximize your comfort and help speed your recovery. Intermittent muscle spasms and feelings of tightness are normal and will subside as your swelling resolves.


Scar lines tend to improve in appearance for up to a year and are usually faded by 12-18 months.


Some numbness in the skin is normal after surgery. Occasionally, the recovery of sensory nerves can result in tingling, itching, or mild electrical sensations that come and go. These sensations will resolve over time and are usually accompanied by some return of feeling in the skin.

APEX FlapSM Breast Reconstruction Recovery Time

You may resume your normal activities as recommended by your surgeon. In most cases, avoidance of strenuous activity is recommended for 4-6 weeks. As a general rule, most patients can drive between 2-3 weeks after surgery if you are no longer using pain medication and your doctor has cleared you. You should maintain range of motion and gentle stretching is recommended for the shoulders beginning in the early weeks after your procedure. Your clinic team can provide specific instruction for a post-mastectomy range of motion exercises as applicable. Patients are generally released to return to full activities and work schedule between 4-6 weeks after surgery. Your clinic team will provide any necessary documentation for your employer.

Your Return Home

If you are traveling from out of state or internationally for care with us, your caregiver will need to be with you throughout your stay post-discharge and on the same flight home to assist you in the airport. Your caregiver’s education will be provided by our nursing staff during your time with us and our team is available to you and your assistant 24 hours/day should any questions arise after you are released from the hospital. Your arrangements for assistance after surgery should include an estimated week to ten days of availability from your caregiver.

We Are Here For You

Be reassured that you are being attended to by some of the most highly skilled and dedicated healthcare providers in the world. Do your best to relax knowing that we are going to take excellent care of you from the moment you enter our facility. Do not hesitate to ask for any special needs you may have.