DIEP Flap Surgery

DIEP flap surgery is a highly specialized breast reconstruction procedure that uses your own abdominal tissue, including skin and fat, to create a new breast after a mastectomy. It is a complex operation performed by trained surgeons, designed to offer a natural-feeling and permanent breast without using implants or sacrificing abdominal muscles.

What is DIEP Flap Surgery?

DIEP flap surgery is a type of breast reconstruction that uses tissue from your lower abdomen to create a new breast after a mastectomy, which is the surgical removal of a breast. This procedure is named after the Deep Inferior Epigastric Perforator (DIEP) artery, which supplies blood to the transferred tissue, and it is known for preserving your abdominal muscles.

During a DIEP flap procedure, surgeons carefully remove a section of skin, fat, and blood vessels from your lower belly, similar to a "tummy tuck." This tissue is then meticulously transferred to your chest to form a new breast mound. Unlike some other flap surgeries, the DIEP flap technique preserves the rectus abdominis muscles (the "six-pack" muscles) in your abdomen. This preservation helps maintain abdominal strength and reduces the risk of complications like hernias or bulging in the abdominal wall. The transferred tissue is connected to blood vessels in your chest using microsurgery, a technique that involves stitching very small blood vessels together under a microscope. This connection is vital for the survival of the new breast tissue. The goal is to create a soft, natural-feeling breast that matches your other breast in appearance and texture, offering a permanent solution for breast reconstruction.

Why it's done

DIEP flap surgery is primarily performed for breast reconstruction after a mastectomy, often due to breast cancer or as a preventive measure for those at high risk. It offers a natural alternative to breast implants, using your own body tissue to create a breast that can feel and look more natural, and it is a permanent solution that grows and changes with your body.

Many people choose DIEP flap surgery because it uses their own body tissue, which can feel softer and more natural than a breast implant. The reconstructed breast often has a more natural shape and texture, and it can age with you, gaining or losing weight just like your natural breast tissue. This can lead to higher satisfaction with the aesthetic outcome and body image. Another significant advantage is that DIEP flap reconstruction avoids the potential long-term issues associated with implants, such as rupture, deflation, or the need for future surgeries to replace them. It also preserves the abdominal muscles, which is a key benefit over other types of abdominal flap surgeries that might involve cutting through these muscles. This makes it a preferred option for many individuals seeking a durable and natural-feeling breast reconstruction.

How to prepare

Preparing for DIEP flap surgery involves several steps to ensure you are healthy and ready for the procedure. Your medical team will conduct a thorough evaluation, including physical exams and imaging tests, and provide specific instructions on medications, diet, and lifestyle changes like stopping smoking to optimize your recovery and reduce risks.

Before surgery, you will have multiple appointments with your surgeon and other specialists. They will assess your overall health, review your medical history, and discuss any existing conditions. Imaging tests, such as a CT angiogram, may be performed to map the blood vessels in your abdomen, helping the surgeon plan the procedure precisely. You will also undergo standard pre-surgical blood tests and an electrocardiogram (ECG) to check your heart health. Your doctor will advise you to stop taking certain medications, such as blood thinners, several days or weeks before surgery to minimize bleeding risks. If you smoke, you will be strongly encouraged to stop completely, as smoking significantly increases the risk of complications and can impair healing. You will also receive instructions on when to stop eating and drinking before the surgery. It is important to arrange for someone to drive you home after your hospital stay and to help you during the initial recovery period.

What happens during

During DIEP flap surgery, you will be under general anesthesia. The procedure involves two main surgical sites: your abdomen, where skin, fat, and blood vessels are carefully removed, and your chest, where this tissue is meticulously reconnected using microsurgery to form a new breast. This complex operation typically takes several hours to complete.

The surgery begins with the plastic surgeon making an incision across your lower abdomen, similar to a "tummy tuck" incision. A section of skin, fat, and the Deep Inferior Epigastric Perforator (DIEP) blood vessels are carefully dissected and separated from the underlying abdominal muscles. The abdominal muscles themselves are left intact, which is a defining feature of this procedure. Once the tissue is harvested, the abdominal incision is closed, often resulting in a flatter abdominal contour. Simultaneously, or in sequence, the breast surgeon prepares the chest area where the new breast will be created. The harvested abdominal tissue, now called the "flap," is then moved to the chest. Using specialized instruments and a microscope, the tiny blood vessels from the flap are painstakingly connected to blood vessels in your chest. This critical step, known as microsurgery, ensures that the transferred tissue receives a continuous blood supply, allowing it to survive and thrive. The surgeon then shapes the flap to create a natural-looking breast mound, and incisions are closed with sutures.

Recovery & timeline

Recovery from DIEP flap surgery is a gradual process that requires a hospital stay of usually 3 to 7 days, followed by several weeks of limited activity at home. You will experience pain and discomfort, managed with medication, and will need to avoid strenuous activities for about 6 to 8 weeks as your body heals and swelling subsides.

Immediately after surgery, you will be closely monitored in the hospital. You will have surgical drains in both your abdomen and chest to collect fluid, which are typically removed within one to two weeks. Pain medication will be provided to manage discomfort. You will be encouraged to start walking short distances soon after surgery to help prevent blood clots and promote circulation, but heavy lifting and strenuous activities will be strictly prohibited. Once you return home, it's crucial to follow your surgeon's instructions for wound care, drain management, and activity restrictions. You will likely feel tired for several weeks. Most people can return to light daily activities within 2 to 4 weeks, but a full return to work and exercise usually takes 6 to 8 weeks or longer. The reconstructed breast will continue to settle and soften over several months, and the final aesthetic result may not be fully apparent for up to a year. Physical therapy may be recommended to help regain strength and flexibility.

Risks & side effects

Like all major surgeries, DIEP flap surgery carries potential risks and side effects, including general surgical complications like infection, bleeding, and pain. Specific risks related to DIEP flap include issues with the transferred tissue, such as partial or complete flap failure, fat necrosis, and potential complications at the abdominal donor site like weakness or bulging.

General surgical risks include adverse reactions to anesthesia, blood clots (deep vein thrombosis), and seroma (fluid collection under the skin). Infection at either the breast or abdominal incision site is also a possibility, though antibiotics are often given to help prevent this. Pain and swelling are expected after surgery and are managed with medication. Specific risks associated with the DIEP flap procedure include flap failure, where the transferred tissue does not receive enough blood supply and dies. This is a rare but serious complication, occurring in about 1 in 100 cases (1%). Partial flap loss, where only a portion of the tissue dies, is more common. Other potential issues include fat necrosis, which is the formation of hard lumps in the reconstructed breast due to fat tissue death, and asymmetry between the reconstructed breast and the natural breast. At the abdominal donor site, risks include numbness, abdominal wall weakness, or bulging, although these are less common with DIEP flap compared to other abdominal flap procedures due to muscle preservation.

Success rate

DIEP flap surgery has a high success rate for flap survival, meaning the transferred tissue successfully establishes blood flow and thrives, typically exceeding 95%. Patient satisfaction with the aesthetic outcome and natural feel of the reconstructed breast is also generally very high, making it a preferred option for many seeking permanent breast reconstruction.

The success of DIEP flap surgery is primarily measured by the survival of the transferred tissue, which is consistently high. Studies show that the rate of complete flap survival is often greater than 95%, meaning that in most cases, the new breast tissue successfully integrates and receives adequate blood supply. This high success rate is a testament to the advanced microsurgical techniques used by experienced surgeons. Beyond flap survival, patient satisfaction is a key indicator of success. Many individuals report high satisfaction with the natural look and feel of their reconstructed breast, often preferring it over implant-based reconstruction. Factors influencing success include the surgeon's experience, the patient's overall health, and adherence to post-operative care instructions. While complications can occur, the overall outcome for most patients is a durable, natural-looking breast reconstruction that significantly improves quality of life after mastectomy.

Frequently asked questions

How long does DIEP flap surgery take?

DIEP flap surgery is a complex procedure that typically takes between 6 to 12 hours to complete. The exact duration depends on factors like the surgeon's experience, the complexity of your anatomy, and whether one or both breasts are being reconstructed.

Will I have a 'tummy tuck' after DIEP flap surgery?

Yes, the process of removing tissue from your lower abdomen for the DIEP flap often results in a flatter abdominal contour, similar to the outcome of a cosmetic tummy tuck (abdominoplasty). The incision is usually made low on the abdomen, from hip to hip, and the remaining skin is tightened.

Is DIEP flap surgery painful?

You will experience pain and discomfort after DIEP flap surgery, both at the breast reconstruction site and the abdominal donor site. Your medical team will provide pain medication to manage this effectively. The pain typically lessens significantly over the first few weeks of recovery.

How long is the hospital stay for DIEP flap surgery?

Most people stay in the hospital for approximately 3 to 7 days after DIEP flap surgery. This allows medical staff to monitor your recovery, manage pain, and ensure the transferred flap is healthy and receiving adequate blood supply before you return home.

Can I get DIEP flap surgery if I've had a previous tummy tuck?

Having a previous tummy tuck (abdominoplasty) can make DIEP flap surgery more challenging or even impossible. A prior tummy tuck may have removed the necessary blood vessels or compromised the tissue needed for the flap. Your surgeon will need to carefully evaluate your abdominal anatomy to determine if you are still a candidate.

Will I have sensation in my new breast after DIEP flap surgery?

While some sensation may return over time, it is unlikely that your reconstructed breast will have the same level of sensation as your natural breast. Nerve connections are typically not re-established during the microsurgical process, though some patients report a return of partial feeling or touch sensation in the months and years following surgery.

Sources

• MedlinePlus — DIEP Flap Surgery
• Mayo Clinic — DIEP Flap Surgery
• Cochrane Library — DIEP Flap Surgery