APEX FlapSM – The Newest Advancement In Breast Reconstruction

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APEX FlapSM – The Newest Advancement In Breast Reconstruction

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Plastic & Reconstructive Surgery

“Myth-busting the DIEP Flap and An Introduction to the Abdominal Perforator Exchange (APEX) Breast Reconstruction Technique:

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World-renowned surgeons at the Center for Restorative Breast Surgery in New Orleans have just published an article in this month’s edition of the Journal of Plastic and Reconstructive Surgery that unveils their newest pioneering advancement called the APEX FlapSM. In this landmark publication, entitled “Myth-busting the DIEP Flap and An Introduction to the Abdominal Perforator Exchange (APEX) Breast Reconstruction Technique: A Single-Surgeon Retrospective Review,” lead author, Dr. Frank J. DellaCroce, exposes little-known problems with popular reconstructive procedures for women facing mastectomy. They further describe how their group has innovated to fix the fundamental flaws of the widely known “DIEP” technique. “What we learned is that, despite popular perception, the DIEP procedure doesn’t always deliver on its promise of being a quality way to spare abdominal muscles and strength when performing natural tissue breast reconstruction. When forced, it can leave damage in the abdominal wall and produce a reconstructed breast with internal scarring and hard spots known as fat necrosis.” The surgeons spent over 8 years pioneering a way to reliably reduce the problems, improve cosmetic results, and add lasting softness to the newly reconstructed breast. Duly named the APEX Flap℠ to represent the quality improvements, this procedure has been performed routinely over the last decade at the Center for Restorative Breast Surgery (CRBS) with enhanced clinical outcomes compared to the DIEP alone.

As the paper states, the blood vessels can take unexpected paths as they pass through the abdominal structure and may not naturally fall in the right location for the older procedures. In these cases, doctors may cut through the “6-pack” muscles that are in the way, defeating the basic purpose of the DIEP technique. After seeing women referred in from around the country with problems, a pattern was noted in some women who had significant abdominal issues or rock-hard breasts after surgery. “They were surprised to learn that, before our publication, there was no framework to standardize how these procedures should be done or what they should be called,” states DellaCroce.

A total of 364 procedures were performed between 2011 and 2017 in the study with very low rates of abdominal problems or breast fat necrosis. Before the development of the APEX conversion, surgeons were left to choose between cutting the muscle and nerve bundles to bring more vessels together or sacrificing those vessels and reducing blood flow in the new breast fat. “We’re now able to produce consistently softer breasts compared to the DIEP alone and more reliably protect abdominal strength.” The surgeons at the CRBS use the APEX FlapSM as an alternative to TRAM Flap conversion when DIEP isn’t the best choice for maximization of blood flow and muscle preservation.

“The point is to deliver what patients think they are getting when they choose to have a procedure of this type.” Dr. DellaCroce and his colleagues also encourage practitioners to photographically document the quality of abdominal structure preservation in the patient’s medical record. “This encourages precision, I think. It lets us gather data about what we’re doing, and I believe it’s reassuring for the patients. If you can’t record the quality, you can’t make any assumptions about how your work was done,” states DellaCroce. “Documentation of this type is common in other fields like orthopedics and laparoscopic surgery, so adding it here is sensible and patients should ask about it.”

“The APEX FlapSM really brings this art into line with the premise of its concept. We have found that many women are not getting the results they expected from their DIEP Flap surgeries,” states Dr. DellaCroce. “We set out to open the dialogue on the little-discussed problems with existing procedures and create a solution for women who want the best in overall outcomes. We believe that open disclosure, technical progress, and objective documentation of work quality are how we best move forward with serving women who seek natural tissue breast reconstruction. The APEX FlapSM advancement is a big step in that direction.”

More About Recent Advancements in Breast Reconstruction

Table of Contents

Key Insights

  • The APEX Flap℠ represents a significant advancement in natural tissue breast reconstruction, developed by the Center for Restorative Breast Surgery (CRBS) in New Orleans.
  • Published in the Journal of Plastic and Reconstructive Surgery, the APEX Flap℠ improves upon the DIEP Flap by protecting abdominal muscles, increasing blood flow, and reducing the risk of fat necrosis.
  • Over more than eight years of surgical refinement, CRBS surgeons created a reproducible technique that restores natural softness and contour for women after mastectomy.
  • In a review of 364 procedures performed between 2011 and 2017, the APEX Flap℠ demonstrated very low complication rates and improved patient outcomes.
  • The technique establishes a standardized framework for quality and documentation in advanced breast reconstruction, shaping the future of restorative surgery.

The Center for Restorative Breast Surgery in New Orleans has pioneered a groundbreaking advancement in natural tissue breast reconstruction: the APEX Flap℠.

Detailed in the Journal of Plastic and Reconstructive Surgery study, “Myth-busting the DIEP Flap and An Introduction to the Abdominal Perforator Exchange (APEX) Breast Reconstruction Technique,” this innovation redefines outcomes for women undergoing breast reconstruction after mastectomy.

Developed by CRBS Co-Founder Dr. Frank J. DellaCroce and his surgical team, the APEX Flap℠ builds upon and refines the principles of the DIEP Flap, restoring softness, strength, and a natural contour to the reconstructed breast.

From DIEP to APEX: Redefining What’s Possible

Myth-busting the DIEP flap

The DIEP Flap was designed to use a woman’s own tissue to rebuild the breast while sparing the abdominal muscles. Yet, as Dr. DellaCroce explains, “despite popular perception, the DIEP procedure doesn’t always deliver on its promise.”

In certain cases, the traditional DIEP method can inadvertently damage abdominal muscles or lead to firm internal scarring known as fat necrosis. This happens when blood vessels take unexpected paths through the abdominal wall, forcing surgeons to cut through the “six-pack” muscles that the operation was meant to preserve.

The innovation behind the APEX Flap℠

Over more than eight years, CRBS surgeons developed a refined solution: the Abdominal Perforator Exchange (APEX) Flap℠. This evolution of the DIEP technique provides a reliable, anatomically adaptive approach to minimize complications, enhance circulation, and preserve abdominal integrity.

The APEX Flap℠ has now been performed routinely for over a decade at CRBS, consistently producing softer, more natural-feeling results and measurable improvements in long-term outcomes.

The Benefits of the APEX Flap℠ Approach

Improved anatomy preservation

The APEX Flap℠ provides a standardized approach to muscle preservation. By precisely identifying and preserving perforator vessels, surgeons can avoid cutting through key muscle fibers, thereby maintaining core strength and optimizing recovery.

Proven outcomes

Between 2011 and 2017, the CRBS team performed 364 APEX procedures with exceptionally low rates of abdominal complications and fat necrosis. Compared with traditional DIEP, the APEX technique consistently demonstrates:

  • Enhanced blood flow to the reconstructed breast
  • Reliable abdominal muscle preservation
  • Improved tissue softness and symmetry

A consistent framework for surgical quality

Before this innovation, no universal standard existed for naming or performing advanced perforator flap procedures. The APEX Flap℠ introduces a structured surgical framework, defining clear criteria, terminology, and expectations for technique and outcomes.

As Dr. DellaCroce explains, “The point is to deliver what patients think they are getting when they choose to have a procedure of this type.”

Setting a New Standard in Surgical Documentation

In addition to surgical innovation, the CRBS team emphasizes the importance of objective documentation in reconstructive surgery.

Dr. DellaCroce encourages surgeons to photographically document abdominal preservation in each patient’s record. “This encourages precision,” he says. “It lets us gather data about what we’re doing, and it’s reassuring for the patients. If you can’t record the quality, you can’t make any assumptions about how your work was done.”

This approach aligns with established best practices in other surgical disciplines, such as orthopedics and laparoscopic surgery, where data transparency drives continuous improvement and patient confidence.

What Patients Can Expect

The APEX Flap℠ technique fulfills the original promise of natural tissue breast reconstruction: restoring the breast with living tissue while preserving abdominal strength.

“We set out to open the dialogue on little-discussed problems with existing procedures and create a solution for women who want the best in overall outcomes,” says Dr. DellaCroce. “The APEX Flap℠ advancement is a big step in that direction.”

Women who undergo the APEX Flap℠ can expect improved comfort, sustained core function, and a more natural appearance and feel, reflecting CRBS’s ongoing commitment to excellence, innovation, and compassionate care.

Frequently Asked Questions

What makes the APEX Flap℠ different from the DIEP Flap?

The APEX Flap℠ refines vessel mapping and tissue transfer to better preserve muscle, optimize blood flow, and achieve a softer, more natural result.

Who is a candidate for APEX Flap℠ breast reconstruction?

Women facing mastectomy or seeking revision of a prior reconstruction may be strong candidates. A personalized consultation with a CRBS surgeon determines suitability.

How does the APEX Flap℠ impact recovery?

Because the technique spares abdominal muscles, patients often experience greater comfort, strength retention, and improved long-term recovery compared with older procedures.

Learn More

For a full look at the clinical publication, see the Journal of Plastic and Reconstructive Surgery article, or schedule an education call with the Center for Restorative Breast Surgery team to learn about your options.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.