What to Expect During DIEP Flap Breast Reconstruction

FAQs About Deep Inferior Epigastric Artery Perforator Flap Reconstruction

After a mastectomy, many women may opt to go through reconstructive surgery to improve the appearance of the breast after surgery. One of the most common procedures is a deep inferior epigastric artery perforator (DIEP) flap reconstruction. 

What Is DIEP Flap Reconstruction?

The DIEP flap 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 DIEP in your tummy area and is a form of autologous reconstruction, a surgery that uses your own tissue.

While this procedure can improve your breast's appearance, you should know ahead of time that it still won't look like your natural breasts. While some women only undergo a DIEP flap reconstruction, others opt to have additional reconstructive surgery to create the appearance of a ​nipple and areola.

What Should I Expect During the Procedure?

Your surgeon will move the skin and fat from your stomach 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 stomach is similar to the procedure for a ​tummy tuck. A DIEP flap 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.

What Are the Advantages and Disadvantages of DIEP Breast Cancer Reconstruction?

With this method, no muscle is moved or repositioned like it would be with a TRAM flap. There is very low risk of developing an abdominal hernia and it is faster, with less pain, than a TRAM flap. The removal of the DIEP and fat gives you a tummy tuck, or a slimmer belly, at the same time of having your breasts reconstructed. The procedure has a less than 1% failure rate. 

However, compared to a TRAM flap, DIEP requires more time in surgery. Two scars will result from a DIEP and if the procedure does fail, the tissue flap may die and have to be removed. New construction will have to be put on hold for 6-12 months. 

Am I a Good Candidate?

If you do not have enough stomach fat or are very thin, you will probably not be a good candidate for this procedure. Additionally, if you're an active smoker, your scar will heal more slowly and fat tissue is more likely to develop into scar tissue. 

How Long After a Mastectomy Do I Have to Wait for Reconstruction?

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, your doctor may recommend that you delay having reconstruction. Having the procedure done before radiation is completed really limits a radiation therapist's ability to properly treat your cancer.

When Should I Consult a Plastic Surgeon?

If you are thinking about reconstruction, it's a good idea to 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 your natural shape and size as possible. If you've consulted with him beforehand, your plastic surgeon will give you a range of choices, helping you save breast skin and prevent unnecessary scars.

How Will My Surgeon Plan for the Procedure?

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 stomach, 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 stomach. This is the same procedure that precedes a tummy tuck.

What About Skin, Fat, and Blood Supply?

Your surgeon will make an incision along the marked skin on your stomach, 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 stomach 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.

How Is the New Breast Created?

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 to help with healing.

What Can I Expect During Recovery?

You should plan on staying in the hospital for 3 or 4 days after this surgery, so that nurses can keep an eye on your healing process. Pack loose, comfortable clothing for your trip home, allowing room for surgical drains. When your fluid build-up has significantly decreased, you may be able to have your drains removed about a week after surgery. Plan on resting for 4 to 6 weeks after a DIEP and make plans to have someone around to drive and lift any heavy objects for you. You will likely have several follow-up appointments so your surgeon can assess your healing progress, incisions, and change your dressings.

Is DIEP Flap Reconstruction an Option After a Double Mastectomy?

If you have enough skin and fat on your tummy to create two new breasts, you can have a DIEP flap reconstruction after a double mastectomy. If you've already had abdominal tissue used for breast reconstruction then you will likely have to undergo a different procedure, such as a lat flap or implant.

Are There Any Special Considerations I Should Know?

DIEP flap is microsurgery, which requires extensive training and experience, in addition to special facilities and surgical tools. The sutures used to reconnect the blood vessels are about the same diameter as a strand of your hair. Your surgical team will use a high-power microscope to reconnect blood vessels, the most critical part of this procedure. ​Choose a surgeon for this reconstruction carefully, asking plenty of questions until you feel comfortable making a decision to go ahead with the procedure.

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