A: Find a plastic surgeon who has done a fellowship in microsurgery and/or who currently does high volume reconstructive microsurgery.
You can usually find a small number of plastic surgeons in a major city, often times at an academic medical center, who perform the DIEP operation or other complex microsurgical procedures on a regular basis. Having a microsurgery fellowship means that the plastic surgeon spent an additional year (after their usual 6-8 years of training) performing high volume, complex microsurgical cases. Very often, these reconstructive microsurgeons are members of the American Society for Reconstructive Microsurgery (ASRM) in addition to the American Society of Plastic Surgeons (ASPS)
It is very rare when a DIEP cannot be performed, but it is ultimatley an intraoperative decision as to whether you end up with a DIEP or some variance of a TRAM. New imaging modalities with CT Angio or Duplex ultrasound can help "map" these vessels and delineate the anatomy better, but there is no guarantee. Your surgeon will always perform the operation that best suits you and your anatomy, to give you the safest and best result.
The best plastic surgeon for you is the one who is qualified and who understands your individual needs and presents the best options for you. I welcome you to contact our office at 415 933 8330 to discuss DIEP breast reconstruction, and/or other autologous (self) tissue options.