What is a DIEP flap procedure?
A DIEP flap, or deep inferior epigastric perforator flap, is a type of breast reconstruction used when reconstructing a woman’s breast after mastectomy for breast cancer. It takes excess fatty tissue from the patient's abdomen and uses it to build a new breast shape. The procedure involves microsurgery to connect small blood vessels between the new breast and existing blood vessels in the chest.
Women who are candidates for a DIEP flap procedure are those who have undergone a mastectomy due to breast cancer or other medical reasons and desire reconstruction with their own tissues. The DIEP flap is most commonly used for immediate reconstruction after mastectomy, but it can also be used for delayed reconstruction. Some reasons why breast reconstruction may be delayed can include additional cancer treatments or waiting for the skin to heal following a mastectomy.
Women who are dissatisfied with their reconstructed breast after implants or have implant complications are also candidates for free flap procedures.
How is a DIEP flap performed?
The DIEP flap breast reconstruction procedure is performed by a plastic surgeon. First, the surgeon will make an incision in the patient's abdomen and remove excess fatty tissue. Next, the surgeon will create a pocket for the new breast implant and insert it into the pocket. Finally, the surgeon will connect small blood vessels between the new breast and existing blood vessels in the abdomen, using microsurgery. Once this is complete, the surgeon will close the incision along the lower abdomen. The final step is to shape a new, aesthetic breast mound.
What is the difference between a DIEP flap breast reconstruction and a TRAM flap?
The DIEP flap and TRAM flap are both types of breast reconstruction procedures used after mastectomy. The main difference between them is that the DIEP flap procedure uses only the superficial skin and fat, while a TRAM flap removes the rectus abdominus muscle. During a DIEP flap surgery, a microsurgeon will carefully separate the abdominal muscles from the skin and fat. This allows them to identify and preserve blood vessels for use in reconstructing the breasts. The abdominal muscle is then sutured back together and allowed to heal during the recovery period in order to ensure successful healing.
Following a DIEP flap or TRAM flap procedure, there is a risk of developing a hernia due to the separation of the abdominal muscles during surgery. This risk is much higher during a traditional TRAM flap procedure, since the entire rectus abdominus muscle is removed along with the overlying fascia. The goal of a DIEP flap is to preserve all or as much of the muscle and fascia as possible, minimizing the risk of hernia or bulge. During recovery time, patients should be sure to follow their doctor’s instructions and avoid lifting heavy items in order to reduce their risks as much as possible.
Do you get a tummy tuck or a flat stomach with a DIEP flap reconstruction?
No, a DIEP flap procedure does not involve a tummy tuck exactly. However, most patients that undergo the procedure report an improvement in their abdominal contour since the excess skin and fat are removed to create a breast mound during breast reconstruction.
What is better between DIEP flap breast reconstruction or breast implants?
Both DIEP flap reconstruction and implants have their own advantages and disadvantages. The choice between the two types of breast reconstruction depends on the patient's specific needs, preferences, and circumstances. A consultation with a plastic surgeon is recommended to determine which option is best for each individual.
There are several potential complications related to silicone or saline implants, which may be a reason to choose autologous breast reconstruction surgery over implants. Some women who have undergone implant-based breast reconstruction may choose to have them removed and replaced with their own autologous tissue.
Some reasons for implant removal may include:
Capsular Contracture - This condition occurs when the capsule of scar tissue that forms around the implant tightens and squeezes it. Symptoms may include pain, tenderness, hardening, a distorted shape or an unnatural look.
Implant Rupture - Over time, the outer shell of the implant can weaken and rupture due to normal wear and tear or pressure from physical activity or other factors. This can cause silicone gel implants to leak into surrounding tissue and require removal or replacement.
Breast Implant Illness (BII) - Many women have reported symptoms such as rashes, headaches, fatigue, joint pain and nausea that they believe are caused by their breast implants.
Implant Migration or Malposition - Over time, the implant may move away from its original position due to gravitational forces or other factors. This can cause an unnatural appearance in the breasts.
Asymmetrical Breasts - If one implant shifts position, it can cause a noticeable asymmetry between the two breasts that may require additional surgery to correct.
Infection - After surgery, some patients experience swelling, redness and discharge at the incision site which could be signs of infection. It’s important to seek medical attention as soon as possible to avoid further complications.
Pain and Discomfort - Patients may experience pain and sensitivity in the area around the implants due to scar tissue formation.
What is the post-operative recovery time like after a DIEP flap?
The recovery time for a DIEP flap varies from patient to patient, but it usually takes about 4-6 weeks before most patients are able to resume their daily activities. During this time, swelling and bruising may occur, and patients should take care to avoid strenuous activity.
What should you expect after the DIEP flap procedure?
After completing the DIEP flap procedure, patients will typically experience some discomfort and swelling. Most patients are able to resume their normal activities within a few weeks after surgery. You may need to wear a compression garment after surgery in order to help reduce swelling and aid in healing. Your plastic surgeon will provide specific post-operative care instructions tailored to your case.
There are many possible complications after any surgery. Although DIEP flap surgery is generally considered safe and effective, there are some risks and potential complications associated with the procedure. These can include flap loss, infection, hematoma, delayed healing, donor-site pain, seroma and fat necrosis. Additionally, patients may experience numbness in the reconstructed breast after mastectomy or in the tissue flap donor site. Patients should discuss these potential complications with their plastic surgeon prior to undergoing a DIEP flap procedure.
The long-term outlook after DIEP flap breast reconstruction is extremely positive. Patients will typically be able to return to their normal activities within a few weeks and can expect results that are both natural and aesthetically pleasing.
It is important for patients to understand that the reconstructed breasts may change over time due to aging, weight gain or other factors unrelated to the surgery itself. In fact, as time goes on and the flaps are healed, they become more and more a part of you as they integrate into your body!
How do breasts feel after DIEP flap surgery?
Breasts that have been reconstructed with a DIEP flap will feel and look similar to natural breasts. Due to the microsurgery involved in the procedure, it is possible to connect nerves and restore sensation in their reconstructed breasts. This sensation may change over time, but for most women it will never be the same as their natural breast sensation.
Breast reconstruction with implants can provide a more uniform shape and size, however patients may experience some firmness or hardness in their reconstructed breasts. Additionally, the texture of the artificial implants can feel foreign to the touch. Patients may also find that their breasts look slightly different from natural breasts due to the presence of the implants. There are techniques such as fat grafting your surgeon can offer to better camouflage the implant reconstruction.
What size breasts will I have after breast flap reconstruction?
The size of breasts after a DIEP flap reconstruction will depend on the size and shape of the patient’s own tissue used to reconstruct their breasts. The plastic surgeon can give an estimate of what the results may look like once the surgery is complete, however it is impossible to guarantee exact results ahead of time.
How should I prepare for my DIEP flap procedure?
When preparing for your DIEP flap procedure, it is important to discuss any questions or concerns with your doctor in advance. They will provide instructions on how best to prepare for surgery and what lifestyle changes need to be made beforehand. Additionally, patients may want to purchase comfortable clothing that will fit easily over bandages, compression garments, and drainage tubes.
What are options for breast reconstruction after mastectomy?
There are several options for breast reconstruction after mastectomy, including DIEP flaps, implants, TRAM flap procedures, latissimus dorsi flaps, and others. A consultation with a qualified plastic surgeon will help to determine which type of reconstruction is best suited for each individual patient’s needs and preferences.
In addition to DIEP flap, there are several other options for autologous breast reconstruction. Autologous means using your own tissues and avoiding implants. These include latissimus dorsi flaps, TRAM flaps and gluteal free flaps (e.g. SGAP, IGAP, PAP, DUG, TUG, LAP flaps). Each procedure has its own advantages and disadvantages, so it is important to discuss your options with your plastic surgeon in order to determine the best course of action for your individual needs.