DIEP Flap Breast Reconstruction Surgery

Considering breast reconstruction after a mastectomy? The DIEP flap procedure is a highly advanced option that uses your own tissue to create natural-looking breasts. Unlike other methods, it preserves your abdominal muscles, making recovery smoother and reducing complications.

If you’re seeking a reconstruction method that feels and looks natural while supporting long-term health, read on to explore the potential of this innovative procedure.

What is DIEP Flap Breast Reconstruction?

DIEP flap breast reconstruction is a surgical procedure used to rebuild the breast after a mastectomy.

“DIEP” stands for Deep Inferior Epigastric Perforator, referring to the blood vessels that are crucial to the procedure. It involves transferring skin, fat, and blood vessels from the lower abdomen to the chest to form a new breast. Unlike other methods, it does not remove any abdominal muscles, which helps reduce the risk of weakness or complications in the abdominal area.

This technique creates a soft, natural-looking breast and uses your body’s own tissue, making it a popular choice for many patients.

Benefits of DIEP Flap Surgery After Mastectomy

DIEP flap surgery offers several benefits for women undergoing breast reconstruction after a mastectomy:

• Natural Appearance and Feel: Since the procedure uses your own abdominal tissue, the reconstructed breast looks and feels more natural compared to implants.
• No Muscle Damage: Unlike older flap procedures, the DIEP flap preserves the abdominal muscles, reducing the risk of weakness or hernias post-surgery.
• Long-Lasting Results: The tissue used is living and responds to changes in your body, providing more durable results over time compared to implants that may need replacement.
• Improved Abdominal Contour: The procedure also tightens the abdomen, similar to a tummy tuck, offering cosmetic benefits in addition to breast reconstruction.
• Reduced Risk of Implant-Related Issues: Since no synthetic implants are involved, risks such as rupture, infection, or capsular contracture (scar tissue around the implant) are avoided.
• Reduced Long-Term Health Risks: The body’s own tissue is less likely to cause rejection or complications, contributing to better overall outcomes.

These benefits make DIEP flap surgery a preferred option for women seeking a natural, long-term breast reconstruction solution.

Who is a Candidate for DIEP Flap Breast Reconstruction Surgery?

Candidates for DIEP flap breast reconstruction are typically women who:

• Have had or are planning a mastectomy: This procedure is for those needing breast reconstruction after breast cancer surgery or prophylactic mastectomy.
• Have sufficient abdominal tissue: Since the surgery uses skin and fat from the lower abdomen, women with enough tissue in this area are better suited for the procedure.
• Prefer a natural reconstruction option: Women seeking a natural look and feel without the use of implants are good candidates.
• Are in good overall health: Patients must be healthy enough to undergo a complex surgery, including having no serious conditions like uncontrolled diabetes or heart disease.
• Have not had extensive abdominal surgeries: Previous abdominal surgeries, such as tummy tucks, may limit eligibility because they could affect the blood vessels needed for the procedure.
• Non-smokers or willing to quit: Smoking can interfere with healing and blood flow, making it essential to stop before and after surgery.

Consulting with a surgeon will help determine if the DIEP flap is the right choice based on your health, anatomy, and goals.

Who Shouldn’t Have a DIEP Flap Surgery?

Not everyone is a good candidate for DIEP flap surgery. You may not be suited for this procedure if:

• You lack sufficient abdominal tissue: If you are very thin or don’t have enough tissue in your lower abdomen, it may be challenging to perform the surgery.
• You’ve had major abdominal surgeries: Previous surgeries like tummy tucks, liposuction or certain hernia repairs may disrupt the blood vessels needed for DIEP flap surgery, limiting its feasibility.
• You have serious health conditions: Conditions such as uncontrolled diabetes, heart disease, or poor circulation may increase surgical risks and complicate recovery.
• You smoke: Smoking impairs blood circulation and healing, making complications more likely. You must quit smoking well before and after the procedure to be considered.
• You’re unwilling to undergo a long surgery or recovery: DIEP flap surgery is more complex and has a longer recovery time compared to implant-based reconstruction.
• You prefer implants: If you’re looking for a faster, less invasive option, implants may be more suitable.

Your surgeon will evaluate your health and anatomy to decide if DIEP flap surgery is the right option for you.

What Are the Expected Results of DIEP Flap Breast Reconstruction?

DIEP flap breast reconstruction provides natural, long-lasting results, helping many women feel confident and comfortable with their new appearance. By understanding the expected outcomes, you can make informed decisions and set realistic goals for your reconstruction journey.

Natural Look and Feel of the Reconstructed Breast

One of the biggest advantages of DIEP flap surgery is the natural look and feel it provides. Since the procedure uses your own tissue, the reconstructed breast has a softness and contour that is closer to a natural breast compared to implants. The transferred tissue is made up of skin and fat, similar to what naturally composes the breast. This means that, unlike implants, the breast will feel more like your own body.

Additionally, because the tissue is alive and connected to your blood supply, the reconstructed breast can change with your body over time, adapting to weight changes or aging. Many patients appreciate this natural integration, both in terms of aesthetics and sensation.

Longevity and Durability of DIEP Flap Reconstruction

DIEP flap reconstruction offers long-lasting results. Since the tissue used is your own, the chances of complications like implant rupture or capsular contracture (a condition where scar tissue forms around an implant) are eliminated. This significantly reduces the need for future surgeries that might otherwise be required to repair or replace implants.

The durability of the DIEP flap also means fewer concerns about long-term issues. Over time, the reconstructed breast will age naturally with the rest of your body, unlike implants that may need replacement every 10-15 years. While some cosmetic adjustments might be desired over the years, DIEP flap reconstruction offers a stable and long-lasting result that can save you from multiple procedures in the future.

Achieving the Desired Breast Size and Shape

Achieving the right breast size and shape is a primary concern for many women considering reconstruction. With DIEP flap surgery, the use of your abdominal tissue allows the surgeon to create a breast that matches your natural proportions. While the amount of tissue available from your abdomen can limit how large the reconstructed breast can be, skilled surgeons can shape the breast to closely match your preferences or the appearance of your other breast if only one side is being reconstructed.

Additionally, because the DIEP flap uses living tissue, the shape can often be refined or adjusted over time if needed. Surgeons may also recommend fat grafting, where additional fat is transferred to perfect the shape and fullness of the breast, helping achieve your ideal aesthetic outcome.

Symmetry and Sensation

While the main focus is often on appearance, it’s important to note that DIEP flap surgery can also restore some sensation to the breast over time. Since nerves are involved in the tissue transfer, many patients experience a gradual return of sensation, although it may not be identical to pre-mastectomy levels.

Symmetry between both breasts is another factor to consider. In cases where only one breast is reconstructed, your surgeon can perform procedures on the other breast, such as a lift or reduction, to ensure both sides appear balanced. This holistic approach helps achieve a more symmetrical and pleasing outcome.

DIEP Flap Procedure

The DIEP flap (Deep Inferior Epigastric Perforator) procedure is a highly advanced type of breast reconstruction surgery that uses tissue from your lower abdomen to rebuild the breast after a mastectomy. Unlike older free flap methods, the DIEP flap preserves the abdominal muscles, leading to fewer complications and a quicker recovery.

Below is a step-by-step overview of how the procedure is performed:

1. Preparation and Anesthesia

The procedure begins with the administration of general anesthesia, ensuring you are asleep and pain-free throughout the surgery. Your surgeon will mark the areas of the abdomen and chest to guide the operation. The surgical team will then prepare the necessary instruments and surgical field.

2. Harvesting the Tissue

The surgeon makes an incision along the lower abdomen, similar to a tummy tuck incision. They carefully remove skin, fat, and the perforator blood vessels (small blood vessels that supply the tissue) from the abdominal area. Crucially, the abdominal muscles are left intact, preserving muscle strength and function. This step ensures that the tissue used to reconstruct the breast is healthy and well-vascularized, allowing for better healing.

3. Transferring the Tissue

The harvested tissue, known as the “flap,” is then transferred to the chest area. The surgeon shapes the tissue to recreate the breast mound. During this process, the surgeon connects the blood vessels from the transferred tissue to the blood vessels in the chest using microsurgery. This step is vital because it restores blood flow to the transplanted tissue, ensuring its survival.

4. Shaping and Positioning the Breast

Once the blood vessels are successfully connected, the surgeon carefully molds and shapes the tissue to create a breast that matches your body’s proportions. If you’re having only one breast reconstructed, the surgeon will aim to match the size and shape of your remaining breast. In cases of bilateral reconstruction (both breasts), the goal is to create a symmetrical and natural-looking result.

5. Closing the Incisions

After the breast mound is formed, the surgeon closes the chest incision. The abdominal incision is also closed, and the skin is tightened, often providing the appearance of a flatter abdomen, similar to the result of a tummy tuck.

6. Post-Operative Care

The entire DIEP flap procedure can take 6-8 hours, depending on the complexity. After surgery, you’ll spend a few days in the hospital for monitoring, especially to ensure proper blood flow to the newly reconstructed breast. Compression garments are typically worn around the abdomen to aid healing, and your doctor will provide guidelines for managing pain and care during the recovery period.

How Does DIEP Flap Surgery Compare to Other Breast Reconstruction Options?

Choosing the right breast reconstruction method can be challenging after a mastectomy. With various options available, it’s important to understand how each technique differs in terms of recovery, aesthetic outcomes, and long-term health. Many women struggle to decide between options like DIEP flap, TRAM flap, and implants, often wondering which provides the most natural results or the least complications. Understanding these differences will help you make an informed decision about which option best suits your needs, preferences, and health goals.

DIEP Flap vs. TRAM Flap: Key Differences

Both DIEP (Deep Inferior Epigastric Perforator) flap and TRAM (Transverse Rectus Abdominis Muscle) flap surgeries use tissue from the lower abdomen to reconstruct the breast, but there are crucial differences between the two.

In the free TRAM flap procedure, muscle from the abdomen is removed along with skin and fat to create the new breast. This can weaken the abdominal wall, leading to a higher risk of hernias and longer recovery times due to muscle loss. Some patients may also experience long-term abdominal weakness or discomfort.

In contrast, the DIEP flap preserves the abdominal muscles, using only the skin, fat, and blood vessels. This makes DIEP flap a less invasive option with a faster recovery and a lower risk of hernia or muscle-related complications. Additionally, DIEP flap surgery often results in a flatter abdomen, similar to a tummy tuck, without compromising muscle strength.

Implant Reconstruction vs. DIEP Flap: Pros and Cons

Implant-based reconstruction is another common alternative to the DIEP flap. Breast implants involve placing silicone or saline devices under the skin or muscle to recreate the breast shape. This option is less invasive and generally involves shorter surgery times than flap procedures. The recovery period is also shorter, and there’s no need to transfer tissue from another part of the body.

However, implants come with their own set of risks and limitations. Implants may need to be replaced after 10-15 years, and there is a risk of complications such as rupture, capsular contracture (scar tissue forming around the implant), or infection. In contrast, DIEP flap surgery provides a more permanent solution since it uses your own tissue. The reconstructed breast with DIEP will age and change naturally with your body, providing a softer, more natural appearance.

The downside of DIEP flap surgery is that it involves a longer and more complex procedure with a longer recovery time compared to implants. However, for women looking for a natural look and feel, and fewer long-term complications, the DIEP flap may be the better option.

Choosing Between Immediate and Delayed Reconstruction

Another important consideration is whether to undergo immediate or delayed reconstruction. Immediate reconstruction is done at the same time as the mastectomy, allowing the patient to wake up with a breast mound in place. This option can have emotional benefits, as it avoids the period of having no breast shape. It also typically requires fewer surgeries overall.

However, delayed reconstruction—performed weeks, months, or even years after a mastectomy—might be necessary in certain cases. For example, if you require radiation therapy after your mastectomy, radiation can negatively affect the outcome of immediate reconstruction. Delayed reconstruction allows your body to heal from cancer treatments before undergoing reconstruction, which can lead to better aesthetic results and fewer complications.

Both immediate and delayed reconstruction options can be performed using DIEP flap, TRAM flap, or implants, but the timing may depend on your overall treatment plan and health status.