DIEP Flap Breast Reconstruction
The DIEP flap is the most advanced technique in reconstructive breast surgery. In this method of reconstruction, a woman’s own abdominal tissue is harvested and used to create a beautiful and natural appearing breast.
What is the DIEP Flap PRocedure?
The DIEP flap is an advanced reconstructive procedure that recreates a breast using a woman’s own abdominal tissue.
Skin and fat are removed from the lower abdomen and transferred to the chest. Unlike earlier versions of this procedure, the DIEP flap preserves the rectus abdominis muscles of the abdomen (the 6-pack muscle) by isolating the flap solely on its nourishing blood vessels. These are then connected to blood vessels in the chest using delicate microsurgical techniques. The abdominal tissue is reshaped into a very natural appearing breast. Closure of the abdominal incision contours the abdomen in a similar manner to an abdominoplasty, or tummy tuck.
Benefits of DIEP Flap Breast Reconstruction
- Very natural appearance and feel
- Generally a better match to the other side, particularly if a woman does not want to alter the opposite breast
- Can be larger if a woman has sufficient abdominal tissue
- Ages more like a natural breast
- More reliable when the breast skin is damaged by radiation
- Contours the abdomen like a tummy tuck
- Preserves the muscles of the abdomen (unlike the traditional TRAM flap), maintaining core strength and avoiding abdominal hernias and bulges
- Excellent long-term patient satisfaction
Who Is A Candidate?
A woman who favors reconstruction with her own tissues and has sufficient abdominal tissue to transfer may be a good candidate for a DIEP flap. A very thin person or someone who has had a prior abdominoplasty may be better suited to a different form of reconstruction.
Women who have received prior radiation therapy to the breast or who will require it to treat their breast cancer may benefit from reconstruction with their own tissues. Healthy living tissue tolerates the effects of radiation better and is less likely to develop a serious complication.
A DIEP flap reconstruction requires a more extensive operation and a longer recovery, so patients should be in generally good health.
DIEP FLAP RECONSTRUCTION: WHAT TO EXPECT
- The first stage of reconstruction can usually be performed at the time of the mastectomy.
- If radiation treatments are planned, it is advantageous to place a temporary tissue expander at the initial operation. After radiation therapy is completed and the breast skin recovered, generally 6 months, a second operation is performed to remove the tissue expander and reconstruct the breast using a DIEP flap.
- A one-sided DIEP flap operation takes approximately 4 to 6 hours.
- Patients generally stay in the hospital for 3 to 5 days, but a complete recovery may take 6-8 weeks.
- Subsequent operations are often planned to refine the reconstructed breast, create a nipple, or to balance the opposite side.
Frequently Asked Questions
Can a DIEP flap reconstruction be performed at the time of mastectomy?
In many cases, yes. Immediate breast reconstruction is generally safe, produces the best aesthetic result, and is beneficial to coping with the loss of a breast.
In some circumstances, it is beneficial to perform the DIEP flap reconstruction at a later time, after a woman has completed all her breast cancer treatments. In these cases, a temporary tissue expander is often placed at the time of mastectomy to preserve the breast skin.
Can DIEP flaps be used to reconstruct both breasts if a bilateral mastectomy is performed?
Generally, yes. If a woman has sufficient abdominal fat, one half of the lower abdomen can be used to reconstruct each breast.
What are the risks of DIEP flap breast reconstruction?
Transferring tissue from the abdomen to the chest requires the creation of new connections between their blood vessels. Even with meticulous microsurgical technique, there is an approximately 5% risk of clotting at those connections and flap failure.
Other potential complications of DIEP flap breast reconstruction include: bleeding (hematoma), infection, wound healing problems, and fat necrosis (hard knots that develop in areas of the reconstructed breast with poor circulation).
The abdominal donor site can also develop post-operative complications, such as delayed wound healing, or fluid pockets (seromas). While the DIEP flap operation minimally disrupts the abdominal muscles, there is a low risk of developing a hernia or bulge in the abdomen.
Major blood clots (DVT, deep vein thrombosis or PE, pulmonary embolism) are uncommon but can be dangerous. To prevent this serious complication, patients are encouraged to get out of bed and walk soon after surgery, and are given blood thinners in the hospital and after discharge, usually for 2 weeks.
How long does a DIEP flap operation take, and how long is a patient usually in the hospital?
A unilateral (one-sided) DIEP flap reconstruction takes 4 to 6 hours. Patients are hospitalized for 3 to 5 days to monitor the flap and recover from surgery.
What is the recovery time following a DIEP flap operation?
Patients should be out of bed the day after surgery and then gradually increase their activities from that point forward. While most women have resumed a modified daily routine by 2 to 3 weeks, a full recovery can take 6 to 8 weeks.
Are subsequent surgeries needed after a DIEP flap?
Oftentimes, yes. Women will frequently undergo revision procedures to refine or enhance the appearance of the reconstructed breast. Nipple reconstruction and balancing operations on the opposite breast can be performed at that time as well.
Is breast reconstruction with a DIEP flap better than other types of reconstruction?
Every woman is different. In each case, the best operation is jointly chosen by a patient and her plastic surgeon considering the patient’s body and overall health, treatments that she may require for her cancer, and her goals and preferences. While some patients are better suited to one type of reconstruction or another, it is important to discuss with your plastic surgeon the benefits and risks of each option as they pertain to your care.
How is a DIEP different than a free TRAM?
A DIEP flap harvests lower abdominal skin and fat to rebuild the breast while minimally disrupting the abdominal wall and preserving the rectus abdominis muscles.
A free TRAM utilizes the same tissue but takes with it the underlying rectus muscle. The risks of hernia and abdominal weakness are much greater with this operation.
A muscle-sparing free TRAM harvests a small amount of muscle surrounding the blood vessels to the flap in order to optimize its blood supply. The majority of the rectus abdominis muscle is preserved, so the impact on the abdominal wall is reduced.
Do the surgeons at DAVinci Plastic Surgery perform DIEP flaps?
Yes! Dr. Davison and Dr. Pinell perform DIEP flaps with technical expertise, artistic vision, and compassionate care. They have extensive experience with microvascular breast reconstruction and an outstanding record. In order to minimize patients’ time under anesthesia and to deliver the best possible result, these operations are always performed by both surgeons working as a team.
Does insurance cover DIEP flap breast reconstruction?
Yes. All methods of breast reconstruction after a mastectomy and balancing procedures to the opposite breast are generally covered by insurance.