DIEP flap breast reconstruction involves using the skin, fat, and blood vessels of the lower abdominal region to rebuild a soft, warm, living breast mound on the chest. This method of breast reconstruction is also known as “autologous” or natural tissue reconstruction because it uses the patient’s own tissue without any implants. It can be an excellent option for women who develop radiation damage, or implant-related complications.
What is DIEP Flap Surgery?
“DIEP” stands for deep inferior epigastric perforator, which is the name of the primary blood supply to the specific region of skin and fat in the lower abdominal region. A DIEP flap is a modern version of the more traditional muscle-sparing free TRAM flap, however, the difference being in a DIEP flap, no muscle is used to create the breast. During DIEP flap surgery, only the skin, fat, and blood vessels from the lower abdominal region (similar to the tissue removed in a “tummy tuck”) are taken and used to rebuild a breast mound on the chest. Using specialized microvascular surgical techniques, your surgeon will carefully reattach the vessels from the DIEP flap tissue to the vessels in the chest. Essentially, this is a soft tissue transplant. The result is a soft, warm, living breast mound that will last a lifetime and age naturally with the patient. By sparing the abdominal muscles, abdominal wall strength is better preserved using the modern DIEP flap technique compared to traditional TRAM flaps which take the rectus muscles.
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Who is a Good Candidate for DIEP Flap Surgery?
Ideal candidates for DIEP flap reconstruction are medically healthy and have enough lower abdominal skin and fat volume for donor tissue. Patients who have had extensive abdominal wall surgery, or a previous tummy tuck/abdominoplasty may not be good candidates for DIEP flap breast reconstruction and can consider other donor sites such as the thigh or gluteal regions. To determine if you are a candidate we recommend you come in for a consultation with one of our board-certified plastic and reconstructive surgeons to discuss your goals and determine a customized reconstructive treatment plan.
DIEP Flap Surgery Procedure
DIEP flap surgery is performed under general anesthesia and the entire procedure takes about 6-8 hours. In the pre-operative area, your reconstructive surgeon will mark the lower abdominal tissue in a pattern similar to a tummy tuck procedure, with the goal that your final scar remains hidden within an undergarment or bikini bottom. The lower abdominal skin, fat, and DIEP blood vessels are carefully removed, and the abdominal rectus muscles are spared. The DIEP tissue flap is then carefully transferred to the chest and used to create a new breast mound. Using specialized microvascular surgical techniques, your surgeon will reattach the vessels from the DIEP flap tissue to the vessels in the chest to restore a warm, living, natural breast mound. As part of our Enhanced Recovery After Surgery (ERAS) protocol, the nerves along the abdominal wall and chest are injected with Exparel, a long-acting local anesthetic, and nerve-blocking agent. This helps block pain for up to 3-4 days and minimizes the need for narcotic use after surgery. Once the surgery is complete, you will recover in the hospital for 1-2 days.
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DIEP Flap Recovery
Most patients are ready to go home after a 1-2 nights stay in the hospital. It is important that you follow instructions and avoid being overly active too early. You will have drains, and be given detailed instructions on how to care for them at home. They are usually removed within 1- 2 weeks after surgery. We recommend a family member or close friend stay with you for a few weeks while you recover as you will not be allowed to do chores or engage in heavy lifting. In general, we recommend sleeping in a reclined beach chair position for 2 weeks, and no lifting greater than 5 lbs for 6 weeks. At around 6-8 weeks, you will be allowed to resume normal activity and vigorous unrestricted exercise after 2-3 months.
If you’re interested in learning more about breast reconstruction from Tucson’s leading DIEP flap surgeons, contact our office to schedule an appointment with one of our board-certified plastic and reconstructive surgeon. We can be reached by phone at 520-415-2420 or by filling out our online contact form.
Frequently Asked Questions
How long does it take to recover from DIEP flap surgery?
For the first two weeks after surgery, patients are allowed to walk daily but must avoid chores and heavy lifting. At about one month, most patients will feel back to normal, and are able to return to their usual activity levels within 2-3 months.
How long does abdominal swelling last after DIEP flap?
Abdominal swelling following DIEP flap breast reconstruction can last up to three months or longer, although most visible and tangible swelling will be gone after the first 6-8 weeks.
How do you reduce swelling after DIEP flap?
The best way to reduce swelling is to follow your post operative instructions. You will have activity restrictions for the first few weeks, as well as drains during this time. Abdominal tissue swelling is normal and wearing a light compression garment can help minimize swelling. Lymphatic massage is also very effective to reduce swelling after surgery, as it helps recirculate the lymphatic fluid within the tissue. We recommend patients get a weekly treatment for the first 4-6 weeks after surgery, and longer if possible.
What happens if DIEP flap fails?
The DIEP flap is an excellent approach to breast reconstruction but its not 100% effective in every case. In very rare instances, the tissue transfer does not succeed do to blood flow issues. In these instances, silicone gel breast implants may be an alternative reconstructive option, or using another body site for donor tissue such as the thighs or buttocks may be used.
What should I wear after DIEP surgery?
For a few weeks following DIEP surgery, youll be instructed to wear a compression undergarments to help minimize swelling and protect the surgical sites. After that, we typically recommend patients wear a tight Spanx to help minimize swelling.
Do you have feeling in your breast after DIEP flap surgery?
Sensation typically does not return after DIEP flap surgery. When DIEP flap surgery is performed, only the artery and vein are transferred to the chest area. Although there have been numerous studies on the success of nerve transfer during time of DIEP flap surgery, the results have been poor. That being said, even without nerve transfer, a small fraction patients do report return of some breast sensation, which may be similar to “phantom” sensations.
How do you prepare for a DIEP surgery?
Preparing for DIEP surgery involves detailed discussions with your plastic surgeon and potentially your oncologist for how best to go about your unique surgical plan. We will review all the details about the surgery, your hospital stay, and post operative recovery with you at your pre-operative appointment. We recommend you bring the family member who will be helping you in the weeks after surgery to this pre-operative appointment. We suggest you take a least 4-5 weeks off from work and strenuous activity so you can heal properly.
Is DIEP flap surgery covered by insurance?
DIEP breast reconstruction is covered by health insurance. Patients should review their benefits, and expect that they will need to undergo an approval process prior to surgery.
Is mesh used in DIEP flap surgery?
Mesh has been increasing used in breast reconstruction to support the new tissue mound. Your surgeon will determine if mesh is necessary in your treatment plan, but know that most often it can be avoided in DIEP flap breast reconstruction.
Is DIEP surgery safe?
DIEP flap surgery is safe when performed by experienced, fellowship trained, and board-certified plastic surgeons like Dr. Mahabir and Dr. Kurtovic. Collectively they have performed over 1500 DIEP flap surgeries, and prioritize your safety during the procedure. The surgery is performed under general anesthesia in a hospital, and uses enhanced recovery after surgery protocols to improve patient outcomes. You will be monitored in the hospital for 1-2 nights to ensure your meet milestones for safe discharge home with your caregiver.
What is the difference between a TRAM flap and DIEP flap?
A TRAM flap takes the entire rectus muscle with the skin and fat, whereas a DIEP flap takes only the skin and blood vessels and preserves rectus muscle function. The benefit of a DIEP flap is that by preserving the recuts muscle, abdominal wall strength is maintained.
What does DIEP stand for?
DIEP stands for deep inferior epigastric perforator artery, which is the main artery and blood supply to the specific area of lower abdominal tissue skin and fat.
How long does pain last after DIEP flap surgery?
DIEP surgery usually results in manageable discomfort which can be alleviated with over-the-counter or prescription medicine as needed. By implementing enhanced recovery after surgery protocols, we performed nerve blocks along the abdominal wall in surgery using a long acting anesthetic called Exparel which helps numb the surgical site for several days, and minimizes the need for narcotics after surgery. We also prescribe muscle relaxers and recommend Tylenol and anti-inflammatory medications for discomfort.
How long is hospital stay after DIEP flap surgery?
Most patients require 1-2 night stay in the hospital to monitor the abdominal tissue that was transferred and to make sure patients their meet milestones for safe discharge home with their caregiver.
