By Douglas A. Roth, MD FACS | Plastic Surgery & Cosmetic Surgery
Women undergoing single or double mastectomy as part of their breast cancer treatment have the option to select an advanced microsurgical plastic surgery technique – the DIEP flap – for autologous tissue breast reconstruction. DIEP is an acronym for Deep Inferior Epigastric Artery Perforator, the system of lower abdominal wall blood vessels that are used to perfuse the tissue for the newly reconstructed breast.
This muscle-sparing procedure, which has gained increased popularity among breast cancer patients who are undergoing complete breast removal, effectively recreates one or both breasts using a woman’s own adipose tissue.
The DIEP flap approach involves removing a “carefully contoured” section of fat, skin and small blood vessels from the patient’s lower abdomen (the donor site) and moving it to the chest wall where the plastic surgeon reattaches the vessels and rebuilds the breast. Because no muscle is used as part of the reconstruction, patients recover quicker, with no risk of losing abdominal strength.
The DIEP flap is an excellent choice for patients who want natural breast reconstruction, have adequate abdominal tissue available to perform the procedure and are good candidates medically to undergo the surgery. The technique provides women with breasts which are natural in appearance and texture. It is also a more desirable approach than the use of implants, which normally must be replaced approximately every 10-15 years.
An added advantage of the procedure is that it leaves women with a flatter stomach. Because extra fat and skin are removed from the abdominal wall, the surgery gives patients a “tummy tuck,” which, for those who have just lost a breast to cancer, can be one piece of good news emotionally.
Studies have shown the DIEP flap approach to be safe and reliable with minimal complications.
Women who opt for DIEP flap surgery can expect a three-to-four-day stay in the hospital. Soreness associated with the chest and abdominal incisions is expected, and certain activities during the recovery process are limited. The procedure normally leaves the patients with a scar below the “bikini line.” The breast scars have been customized to be short and hidden. For some patients, the nipple areolar complex can be saved and gives a very natural end result.
Many patients who are diagnosed with breast cancer and are recommended to undergo a single mastectomy often decide to have a double mastectomy to remove the unaffected breast so they do not develop breast cancer again later in life. Patients who have inherited the breast cancer gene typically schedule a bilateral prophylactic mastectomy. These patients meet with the plastic surgeon in advance and if they are candidates for this special procedure, then plans are made for DIEP flap breast reconstruction on the same day as the breast cancer removal surgery.