The DIEP flap reconstruction is named after the deep inferior epigastric, an artery that supplies blood to the vessel(s) connected to the tissue that will be used to reconstruct the breast. Unlike a TRAM flap procedure, no muscle is moved. To learn more about the DIEP flap procedure, I asked some questions of Gabriel Kind, MD, a plastic surgeon who has been performing this procedure since 1998.
Comparing DIEP and TRAM Flap Procedures
Illustration © Pam Stephan
Q: During a TRAM flap procedure, muscle is moved and relocated to help create a reconstructed breast, but during a DIEP, no muscle is moved. What is the advantage of this?
A: Studies have proven that DIEP flap reconstruction can be performed with lower morbidity rates and shorter hospital stays than TRAM reconstruction. Abdominal wall hernias are less common in DIEP flaps because the rectus abdominis muscle is spared, unlike the TRAM flap which requires the removal of this muscle. Since the blood supply is better with the DIEP flap, the incidence of [damage to some of the fat tissue] is lower as compared to the TRAM flap.
Benefits of DIEP Procedure
Q: What are some other benefits of the DIEP procedure that patients would appreciate?A: The appearance of the abdominal wall is improved, as the DIEP harvest is essentially the same as performing a tummy tuck.
Risks of DIEP Procedure
Q: What would some of the drawbacks (or risks) of a DIEP be?A: All microvascular procedures have the risk of total flap loss. Fortunately this risk is quite low, generally about 1% in the hands of experienced microsurgeons. The DIEP flap takes tissue from the abdominal wall. The blood vessels are dissected through the rectus abdominis muscle. In rare instances patients can have abdominal wall bulging after DIEP harvest. This occurs in 2 -3% of DIEP cases, compared to greater than15% of TRAM flap cases.
Best Candidates for DIEP
Q: Can any mastectomy patient have a DIEP procedure?A: No, each patient must be evaluated individually to determine if they have enough abdominal wall tissue to match the breast size that they desire.
Free Flap Microsurgery
Q: A DIEP flap is called a "free" flap breast microsurgery procedure. What is a "free" flap and how does microsurgery facilitate the success of a DIEP flap reconstruction?A: “Flap” refers to tissue harvested from the patient that retains all or a portion of its original blood supply, to be used for reconstruction or wound coverage. The term “free” refers to the transplantation of the flap by completely detaching the blood supply and then reattaching it to recipient vessels using microvascular surgery. DIEP flaps are by definition “free flaps”, in that the DIEP flap is completely disconnected and then reconnected to the body using microsurgery.
Questions to Ask Your Plastic Surgeon
Q: What are some questions a woman should ask a plastic surgeon, before deciding on this reconstruction procedure?A: Ask these questions before deciding on DIEP reconstruction:
- How many DIEPs has the physician performed and how frequently does he/she perform the DIEP flap?
- What is the physician’s success rate for the surgery?
- Is the plastic surgeon in your insurance network?
- What is the postoperative recovery period like?
- Do I have enough belly for this procedure? If not, what other options do I have?
- What other procedures are required to complete my breast reconstruction?
About Dr. Gabriel Kind
Dr. Gabriel Kind
Dr. Gabriel Kind received his undergraduate degree from Dartmouth College, and attended Northwestern University Medical School. Additionally, Dr. Kind was fully trained in General Surgery at Rush Presbyterian St.Luke's Medical Center, and Plastic and Reconstructive Surgery at Northwestern University, McGaw Medical Center. He also completed a fellowship in Hand and Microsurgery at the Davies Medical Center which is now part of California-Pacific Medical Center in San Francisco. Dr. Kind is Board Certified by the American Board of Surgery, by the American Board of Plastic Surgery, and received a Certificate of Added Qualification in Surgery of the Hand from the American Board of Surgery.
Source: Personal correspondence with Dr. Gabriel Kind, January 25, 2008.
Discuss Breast Reconstruction in the Forum
There are many types of breast reconstruction - implants, TRAM, Latissimus Dorsi, SGAP, DIEP Flap. What procedure did you have? Would you recommend it to anyone else? What went right or wrong with your reconstruction?
