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DIEP Flap Breast Reconstruction

Plastic Surgery to Restore Breast Symmetry After a Mastectomy

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Updated April 27, 2012

When considering breast reconstruction, there are several surgical options to consider -- DIEP flap is one of them. Not everyone is a good candidate for the DIEP flap, but there are many advantages to this procedure.

What is DIEP Flap Reconstruction?

The DIEP flap (deep inferior epigastric perforator) is a tissue flap procedure that uses fat and skin from your tummy to create a new breast mound after a mastectomy. This procedure takes its name from the deep inferior epigastric perforator artery in your tummy area and is a form of autologous reconstruction -- a surgery that uses your own tissue.

Your reconstructed breast won't be just the same as your natural breast, and you will need additional reconstructive surgery to create a nipple and areola.

DIEP Flap Method

Your surgeon will move the skin and fat from your tummy area to your chest. No abdominal muscle will be cut or moved during this process. Most women have enough extra tissue in their tummy area to create a new breast. If not, a small implant can be placed under your tissue flap to create the breast size that you want. The removal of skin and fat from your tummy is similar to the procedure for a tummy tuck (abdominoplasty). A DIEP flap, however, also includes the movement of an artery and vein from your tissue flap to the chest so that the transplanted tissue can be supplied with blood.

Advantages and Disadvantages

Pros:

  • no muscle is moved (unlike a TRAM flap)
  • almost no risk of developing an abdominal hernia as a result of this procedure
  • less pain, faster recovery time than a TRAM flap
  • removal of abdominal skin and fat results in a tummy tuck
  • DIEP flap procedure has a less than 1% failure rate

Cons:

  • DIEP requires more time in surgery than a TRAM flap
  • two scars result from a DIEP, as you will have two surgical sites
  • if a DIEP procedure fails, the tissue flap may die and have to be completely removed
  • if the tissue dies, new reconstruction may not be done for 6 to 12 months

You're Not a Good Candidate If:

  • not enough tummy fat (you have already had abdominal skin and fat removed)
  • you are very thin (you don't have ample skin and fatty tissue on your abdomen)
  • you're an active smoker (your abdominal scar will heal slowly, and your fat tissue will more likely develop into scar tissue)

Breast Reconstruction Immediate or Delayed?

Breast reconstruction can be done during a mastectomy or after chemo and radiation. If you need radiation treatments aimed at your underarm area or chest, you would be wise to delay having reconstruction. It is worth your wait: Having the procedure done before radiation is completed really limits a radiation therapist's ability to properly treat your cancer.

Reasons to Consult a Plastic Surgeon Before a Mastectomy

If you are thinking about reconstruction, it's a good idea go see your plastic surgeon before having mastectomy surgery. This gives you the chance to have precise measurements and pictures taken of your natural breasts. A plastic surgeon will use this information to make your reconstructed breast as close to natural shape and size as possible. If you've consulted with him beforehand, your plastic surgeon will give you a range of choices, help you save breast skin and prevent unnecessary scars.

What to Expect During a DIEP Flap Breast Reconstruction

You will have intravenous sedation or general anesthesia during your mastectomy or DIEP reconstruction, so you will not be awake. If you've had previous surgery and experienced nausea and vomiting with anesthesia, ask if you can be pretreated. If you are having immediate reconstruction (mastectomy and reconstruction at the same time), your general surgeon will remove your breast first, sparing as much skin as possible.

Getting Ready for DIEP Flap Breast Reconstruction

DIEP Flap breast Reconstruction
Illustration © Pam Stephan
Your plastic surgeon will mark your skin to carefully plan for the tissue flap incision. Using a skin marker, he will draw a semi-elliptical section across your tummy, just below your navel and above your pubic area. This semi-ellipse will become the skin flap that closes the incision for your reconstructed breast. When the incision for the flap is shut, it will become a line that goes all the way across your tummy. This is the same procedure that precedes a tummy tuck.

Moving Fat, Skin and Blood Supply

DIEP Flap breast Reconstruction
Illustration © Pam Stephan
Your surgeon will make an incision along the marked skin on your tummy, and raise a layer of skin and fat. Before disconnecting this tissue flap, he will search for the deep inferior epigastric perforator artery and vein that will bring a dependable blood supply to your new breast. These blood vessels will be carefully preserved along with your tissue flap. Your tummy incision will be closed, and drains may be placed to promote healing and prevent fluid build-up. Your navel will remain in position above the incision.

Creating Your New Breast

DIEP Flap breast Reconstruction
Illustration © Pam Stephan
Your tissue flap, complete with blood vessels, will be moved up to your mastectomy area. In order to ensure that the tissue will survive in its new location, your surgeon will use microsurgery to reattach the blood vessels in the tissue flap to blood vessels in your chest. Your skin and fat tissue are then carefully reshaped into a breast mound and sutured into place. Your surgeon may use skin marking techniques over the blood vessels to help your nurses monitor healing as you recover. Expect to have surgical drains in this incision, too, to help with healing.
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