DIEP breast reconstruction stands for the Deep Inferior Epigastric Artery Perforator
Flap. This is a technical term which refers to the blood vessels which supply the tissue
from the lower abdomen. Essentially, the procedure involves taking the lower abdomen skin and
abdominal fat and transferring that to the chest to make a breast. It has the advantage
of producing a soft natural looking and natural feeling reconstruction. In suitable patients,
it also has the added bonus of removing some of the excess tissue from the lower abdomen
and essentially performing an abdominoplasty or tummy tuck procedure at the same time.
The DIEP reconstruction procedure can be performed as an immediate procedure at the time of mastectomy.
It can also be performed as a delayed procedure once you've completed your cancer treatment.
In addition, it is also a very useful technique in patients who may previously have had an
implant-based breast reconstruction which has become tighter and comfortable or deteriorated
over time. In such patients, the implant can be removed and the DIEP flap can be used to
reconstruct the breast. DIEP flap reconstruction has become increasingly popular in recent
years and the technique has been refined a lot. It is now a very reliable reproducible
procedure with low complication rates.
So, the DIEP breast reconstruction flap can
be performed at the time of mastectomy; which is called immediate reconstruction or it can
be performed as a delayed procedure once you've completed your cancer treatment. Essentially,
the skin and fat from the lower abdomen is raised as a flap and the blood vessels supplying
the tissue is carefully freed up from the muscle underneath and traced down into the
pelvis. The tissue is then disconnected and transferred to the chest where it is joined
up to blood vessels underneath the ribs using a microscope to restore the blood flow to
the tissue. Once the blood flow to the tissue is established, the tissue is then shaped
and sculptured and tailored to create a breast to match the contralateral breast. We call
this the insect. Once this is complete, the abdomen is closed in a similar fashion to
an abdominoplasty or tummy tuck procedure. This results in a scar from hip to hip and
a small scar around the umbilicus. Surgery typically takes about six to eight hours.
The hospital stay is typically four to five days and the overall recovery period for this
surgery is about three months.
So, DIEP flap reconstruction is big surgery
and your general health needs to be reasonably good to be considered a candidate for it.
Ideally, you should be a nonsmoker. If you've had some previous surgery to your abdomen
that may affect your suitability. We will often get a CT scan of the abdomen to look
at the blood vessels to ensure your suitability. If you're very much overweight, we may ask
you to lose some weight in advance of the DIEP breast reconstruction to reduce the risk
of wound healing complications. In an ideal scenario, you would have enough tissue available
from the lower abdomen to match your current breast size. However, if this is not the case,
you can reconstruct a slightly smaller breast and reduce the other breast or lift the other
breast to match. And for lots of women they may have a preference to reduce their overall
breast size. It can also be considered in slim women by joining up the both sides of
the abdomen to gather more tissue together. However, it does result in a scar in the abdomen.
So, if you have a slim abdomen there's probably a slightly higher price to pay in terms of
the scar on the abdomen. It is a big surgery and it does have a longer recovery period
to say, implant-based techniques. But the long-term results tend to be better and revision
surgery is rarely required into the future.
So, the advantage of the DIEP flap reconstruction
are that it makes use of your own tissues. So, it can produce a breast reconstruction
which feels soft, is warm, and has a more natural appearance than can be achieved with
implant reconstruction for example. It also has the advantage that it ages naturally.
So while implant reconstructions tend to sit higher in the chest, a DIEP flap reconstruction
will tend to age naturally and drop naturally as your natural breast would. For women who
have some extra tissue on the lower abdomen, there is of course the added advantage of
having a tummy tuck or abdominoplasty type procedure at the same time. Another big advantage
is that there are rarely problems in the longer term. So once this reconstruction is complete,
we generally don't see patients again because revision surgery is rarely required. This
is not the case in implant reconstruction for example; which often need surgical revisions
into the future.
There are many ways to surgically reconstruct
a breast. Broadly speaking, they can be divided into implant-based techniques or using your
own tissues called flap techniques. For many women, implant-based reconstruction produces
perfectly satisfactory results and avoids the need for bigger surgery which would be
associated with flap reconstruction and avoids additional scars. Implants can produce good
results in clothing. Although, they don't tend to look as natural as a flap-based reconstruction.
If you are still interested in a flap reconstruction and the abdomen is not available, there are
some other sites where we can harvest tissue from. So, a common procedure to take some
tissue from the medial ties and this is called a tug flap or a TUG flap. Tissue can be harvested
from the buttock area. Some women of course choose not to have a reconstruction and that's
absolutely fine also. And you can always consider a delayed reconstruction down the line. So,
some ladies would choose not to have a reconstruction, see how they get on and then they can think
about their options down the line.