DIEP Flap Breast Reconstruction: What To Expect

FAQs About Deep Inferior Epigastric Artery Perforator Flap Reconstruction

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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. 

The DIEP flap is a tissue flap procedure that uses skin and tissue (no muscle) from the abdomen to create a new breast mound after a mastectomy. This procedure 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 natural. 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.

With this method, no muscle is moved or re-positioned similarly to a TRAM flap, which also uses muscle, fat and skin from the abdomen to create a new breast mound after a mastectomy. 

There is very low risk of developing an abdominal hernia with DIEP, 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.

Before Surgery

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, the scaring 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 chemotherapy 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 limits a radiation therapist's ability to properly treat your cancer.

Consulting 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.

During Surgery

The 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.

The 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.

Skin, Fat, and Blood Supply

The 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 the 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.

New Breast

Your tissue flap, complete with blood vessels, will be moved up to your mastectomy area. In order to ensure the tissue will survive in its new location, the surgeon will use microsurgery to reattach the blood vessels in the tissue flap to blood vessels in your chest. The skin and fat tissue are then carefully reshaped into a breast mound and sutured into place. The 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.

After Surgery

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.

Special Considerations

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.

Double Mastectomy

If you have enough skin and fat on your abdomen 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.

Risks

Every surgery comes with the risk for infection, bleeding, and side effects of anesthesia, and breast reconstruction surgery is no exception. Research shows both DIEP flap surgery-on one or both breasts-is safe and the risk for complications is low. However, reconstruction on both breasts is associated with higher complications and total flap loss, this in comparison to reconstruction of one breast.

Complications and risks associated with DIEP breast reconstruction include:

Breast fat lumps: DIEP flap reconstruction can lead to breast fat lumps. These are made up of scar tissue called fat necrosis. These lumps may be uncomfortable, and you may need surgery to remove these lumps.

Fluid buildup: Fluid and blood accumulation after surgery in the new breast is usually absorbed by the body. Other times, your doctor may need to drain the fluid.

Sensation loss: The new breast will not have normal sensation. Normal sensation in the breast may never return, but it is possible to get some sensation back.

Blood clots: After surgery, you are at risk for clots in your legs or your lungs. To prevent blood clots, nurses will get you up right away and encourage to move around. 

Tell your doctor if you:

  • Have a painful, red, swollen leg that may be warm to touch
  • Are feeling breathless
  • Have pain in your chest or upper back
  • Are coughing up blood

Tissue rejection: While rare, tissue rejection can affect a small number of people who have a DIEP surgery. Tissue rejection is called tissue necrosis, which means the entire flap has failed. If this happens, the dead tissue flap with be removed and surgery can be re-attempted in 6 to 12 months.

Scars: The DIEP flap reconstruction can cause scars around the breasts and belly button. Sometimes, these scars can develop overgrown scar tissue.

A Word From Verywell

Deciding whether or not to have breast reconstruction after a mastectomy is a personal choice. Breast reconstruction is not medically necessarily but having a reconstruction may help you to manage your emotional and physiological well-being, life quality, and overall outlook.

In addition to DIEP flap reconstruction, there are other different reconstruction options, and each one comes with its own benefits and risks. Your decision on which to do will depend on personal preferences, other medical problems you may have, your overall health whether you have enough abdominal tissue or fat, and previous abdominal surgeries you may have had.

Make sure you discuss all the pros and cons for all of your options with your surgeon before you make a decision on DEIP reconstruction. 

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