The DIEP (deep inferior epigastric perforator) flap is an evolution from the pedicled TRAM flap - whereby part of the flap is left attached to the body’s blood stream. DIEP flaps are only performed by plastic surgeons who are skilled in microsurgery, and in select hospitals with microsurgical expertise. As the lower abdominal tissue must be completely detached from the body and transferred to the chest, microsurgery is required to restore circulation to the transplanted skin and fat. The two benefits of this approach over the pedicled TRAM flaps are:
- little to no rectus muscle is disturbed - which helps to preserve abdominal strength following surgery
- the flap is completely removed from the abdomen and reattached to the blood vessels in the chest, which can provide better blood supply to the new breast
In a small number of cases, the blood supply to the skin and fat of the lower abdomen is insufficient and a small cuff of the abdominal muscle must be taken, to include more blood vessels and help ensure the flap’s survival.
Reconstruction using your own abdominal tissue generally results in a natural feel and look that will last indefinitely. Your new breast will be fully integrated into the body and respond to changes in your body weight as would your natural breast.
When your abdomen is used as the donor tissue for breast reconstruction, the scar will extend from side to side at the level of your pubic hairline. This scar is usually slightly higher than the scar from a cosmetic tummy tuck. Although this method will remove excess skin and fat from your abdomen, it will not make your abdomen completely flat. You must always keep in mind that the main goal of this procedure is to reconstruct the breast following cancer surgery, not flattening of the abdomen.
Recovery from the abdominal flap reconstruction can take 6 to 8 weeks. While most of the physical discomfort subsides within the first two weeks, it is not uncommon to experience fullness, tightness, or numbness. These symptoms will improve over time, but require patience as it can take up to 12 months for these feelings to resolve.
In a small percentage of women, especially those requiring both breasts to be reconstructed, there is an increased risk of abdominal hernia and bulge formation following the abdominal flap procedure. This risk is higher for the TRAM flap than for the DIEP flap procedure in which all the abdominal muscle is left intact.
The main risk of free flap techniques is that microsurgery can fail to reestablish a blood flow connection to the abdominal tissue transferred to the chest. If this happens, the reconstruction will be unsuccessful; if the transferred tissue cannot be saved and another breast reconstruction technique must be used at a later date. Patients who smokers, are obese or have conditions such as diabetes or clotting disorders have greater of microsurgery failure. Also, it takes almost twice as long to complete DIEP flap surgery compared to the TRAM flap technique.
The decision to undergo breast reconstruction is an individual one; there are physical and psychological benefits, but you must be completely committed to the process before you begin. Remember that you can always choose to undergo breast reconstruction later. It is a choice that requires careful and thoughtful consideration, and it is yours alone to make.
- Surgical time: Up to 8 hours for one breast, 10–12 hours for two breasts
- Hospital stay: 3–5 days
- Recovery time: No lifting for 4–8 weeks. 2–3 months to return to normal activities.