DIEP flap (using abdominal tissue)

Delayed Reconstruction

Using Abdominal Fat and Skin
(DIEP Flap Reconstruction- Deep Inferior Epigastric Perforator)

The DIEP flap is regarded as the gold standard procedure for breast reconstruction. This method of reconstruction when used for a delayed reconstruction that is some time after the mastectomy uses skin and fatty tissue from the abdomen to restore the breast. The abdominal skin becomes the breast skin. The abdominal tissue used to rebuild the breast is reattached via blood vessels using microsurgery. 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.

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.

There are ‘pros’ and ‘cons’ to this surgery. 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.
• 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 an operation, usually 5-6 hours of surgery and a 6-7 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.
• There will be an abdominal scar similar to that following a ‘tummy tuck’
• The failure rate is increased by factors such as obesity, smoking, diabetes, radiotherapy and other medical conditions.
• The skin on the reconstructed breast is abdominal skin so will still have any defects originally there i.e. stretch marks
• Secondary operation for nipple reconstruction, and in some cases re-sculpturing of the breast with liposuction or auto fat injections to gain symmetry between the breasts.

Facts at a glance

Images

Case 1

DELAYED DIEP FLAP BILATERAL BREAST RECONSTRUCTION with NIPPLE RECONSTRUCTION and NIPPLE TATTOOING

Case 2