Using Abdominal Fat
DIEP Flap Reconstruction- (Deep Inferior Epigastric Perforator) used with either EMIR (Envelope mastectomy with Immediate Reconstruction) or CAMIR (Circum-areolar mastectomy with Immediate Reconstruction)

The DIEP flap is regarded as the gold standard procedure for breast reconstruction and can be used for immediate or delayed reconstruction. This method, when used at the same time as mastectomy uses just the fatty tissue from the abdomen and not the skin to restore the breast. The breast skin is left behind at the time of mastectomy using either EMIR or CAMIR techniques. The result in the abdomen is similar to that of a tummy tuck meaning that the abdominal contour is usually improved as well. One huge advantage of the DIEP procedure is that it does not affect the muscles of the abdomen.

EMIR(Envelope mastectomy with Immediate Reconstruction) mastectomy is when a neat, single cut is made at the underarm side of the breast and a skin sparing mastectomy performed, that is the breast tissue is removed leaving the breast skin and the nipple. The abdominal tissue using the DIEP flap technique is then used to replace the removed breast tissue and is connected via blood vessels using microsurgery.

CAMIR (Circum-areolar mastectomy with Immediate Reconstruction) mastectomy is different to EMIR in that the nipple is removed and the breast tissue taken away using that opening. The breast is then reconstructed in the same way as with an EMIR, that is using a DIEP flap, but a small amount of abdominal skin is left attached to the abdominal tissue to provide a ‘patch’ to replace the lost nipple.

Several days before the operation the patient will have an anaesthetic assessment to establish that they are fit for the lengthy procedure. This will take into account the patients medical history and their general health.

A CT scan is always carried out prior to surgery. This is used to visualise and assess the flow patterns of arteries and veins and provides information about the best place to the take the tissue from before the operation begins.

Generally there will be two surgeons present at these operations. The Breast Surgeon will perform the mastectomy, and a Plastic Surgeon performs the reconstruction.

As with all procedures there are ‘pros’ and ‘cons’. To help give you an overview the main ones are listed below.

Pros

• Uses your own tissue (fat) which means that your new breast will usually closely resemble the normal breast in texture and movement and in shape and ‘fall’.
• The reconstructed breast will change with the opposite breast If you put on weight the breast will increase in size and similarly a loss of weight will mean the breast will reduce – it will alter and age as you alter and age in shape and size as it is living tissue.
• Scarring on the reconstructed breast, particularly with EMIR reconstruction is minimal and discreet.
• This form of reconstruction usually improves over time.
• Can leave the patient with a flatter tummy.
• Abdominal muscle is left intact, only fatty tissue is taken from donor site
• One main operation.

Cons

• It is a major operation, usually 5-6 hours of surgery and a 7 night hospital stay.
• The flap is monitored every hour for the first three days in a High Dependency Unit (HDU). There is a small risk of failure of the flap at this stage and this could result in emergency surgery.
• 2 month recovery period.
• The failure rate is increased by factors such as obesity, smoking, diabetes, radiotherapy and other medical conditions.
• There will be an abdominal scar similar to that following a ‘tummy tuck’.
• Risks associated with all surgery
• Secondary operation for nipple reconstruction with CAMIR only, and in some cases re-sculpturing of the breast with liposuction or auto fat injections to gain symmetry between the breasts.

Video

Facts at a glance

Images

Case 1

IMMEDIATE DIEP FLAP RIGHT BREAST RECONSTRUCTION with EMIR MASTECTOMY

Case 2