Shannen Doherty
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August 23, 2018 04:19 PM

With her breast cancer in remission for a year, Shannen Doherty underwent her breast reconstruction in May, opting against the more traditional silicone implants.

The actress, 47, decided to undergo a stacked DIEP flap surgery, where the breast is recreated with tissue made up of skin and fat from the lower abdomen. And in Doherty’s case, she actually had to gain weight to get her body ready.

“I was required to gain weight to stretch my skin. I did. I stopped working out and ate. I gained the 7 pounds required,” she wrote on Instagram in July.

This isn’t true of all DIEP flap surgeries — Doherty was in a somewhat unique position to have to gain weight for the procedure.

“In most women, this 75% [of tissue from the abdomen] is adequate for us to successfully reconstruct their breast,” Dr. Babak Mehrara, the chief of Plastic and Reconstructive Surgical Service at Memorial Sloan Kettering Cancer Center in New York City, tells PEOPLE.

But for thinner women, surgeons need to apply a different method to reconstruct the breasts, called a stacked DIEP flap surgery.

“In some cases, for example thin women or women who have relatively large breasts but only a modest amount of fat in their abdomen, we need all of the skin from the abdomen,” Mehrara explains. “In these cases we do a stacked flap in which blood vessels from both sides of the abdomen are connected, therefore the blood supply of the skin is better and we can reliably transfer all of the skin and fat. In some cases, one half of the belly fat is stacked on top of the other half, giving us even more flexibility in reconstructing the breast shape.”

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Mehrara says it’s a complicated decision to go with a DIEP flap over silicon implants.

“Usually, when women select this option they are looking for the best long-term solution to breast reconstruction since these reconstructions age with them — they gain weight when they gain weight and lose weight when they lose weight, the tissue ages more naturally and these reconstructions never need to be redone,” he says.

But there are cons to going with this surgery, particularly for women who are planning to have kids.

“A DIEP flap may make it harder to get pregnant since their belly skin is tightened and won’t stretch as much,” Mehrara says, adding that it also leaves a significant scar in the abdomen.

Plus, the surgery requires a lengthy recovery time. Patients stay in the hospital for two to four days, and are severely limited from daily activities for six weeks. “In general, it takes about three to six months, and sometimes a little longer, to fully recover,” Mehrara says. They also often need a second operation for touch ups, and for nipple reconstruction four to six months after the initial surgery.

But, on the bright side, it requires far less maintenance than silicon implants, which can rupture or leak, and often need to be redone. Instead, Mehrara says he sees his DIEP flap patients about once a year for the first five years after surgery, and then they’re set.

“I recommend this when patients like the concept of a more permanent, natural reconstruction,” he says.

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