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After a mastectomy, you may decide to have breast reconstruction. One option is deep inferior epigastric perforator (DIEP) flap reconstruction, which is the most common type of flap reconstruction.
DIEP flap reconstruction may be done along with certain types of mastectomy, such as skin-sparing mastectomy. Unlike breast implants, DIEP flap reconstruction uses your own tissue and doesn’t remove abdominal muscle.
If you’re considering this procedure, this article answers some top questions about DIEP flap breast reconstruction.
DIEP flap reconstruction can be done at the same time as a mastectomy (immediate reconstruction) or later (delayed reconstruction). In this procedure, skin and fat from the lower abdomen are used to rebuild the breast area.
A plastic surgeon who specializes in microsurgery will perform the procedure. Microsurgery uses specialized instruments and a microscope to connect tiny blood vessels.
During the procedure, the surgeon removes a flap of skin, fat, and small blood vessels from the lower abdomen and transfers it to the chest. The general steps include:
Several factors can help determine whether you’re a good candidate for a DIEP flap reconstruction. These include having enough abdominal tissue, your history of abdominal surgery, and the size and location of blood vessels in your abdomen.
Because DIEP flap reconstruction uses skin and fat from the lower abdomen to rebuild the breast, you must have enough abdominal fat for the procedure. If you don’t, your surgeon may recommend another type of flap reconstruction or another approach.
Certain abdominal surgeries, such as liposuction, ventral hernia repair, laparotomy (open abdominal surgery), and abdominoplasty (a tummy tuck), may affect whether you can have DIEP flap reconstruction. A tummy tuck is a cosmetic procedure that removes excess skin and fat from the abdomen and may also tighten the abdominal muscles.
Having had a colostomy may also prevent you from having DIEP flap surgery. A colostomy connects part of the large intestine to an opening in the abdomen.
Most people who have had a cesarean section, open hysterectomy, or tubal ligation can still be candidates for a DIEP flap. Your surgeon will review your surgical history and abdominal scars to determine whether the procedure is an option for you.
The size and location of blood vessels in the abdomen can affect whether you’re a good candidate for DIEP flap surgery. The transferred tissue needs a strong blood supply to survive and heal. If the vessels are too small or not in a good location, your surgeon may recommend a different type of reconstruction.
DIEP flap surgery has several potential benefits compared with some other types of breast reconstruction.
DIEP flap breast reconstruction surgery may create a breast that looks and feels more natural than one reconstructed with an implant. This is because DIEP flap reconstruction uses your own tissue.
Compared with transverse rectus abdominis musculocutaneous (TRAM) flap surgery, recovery from DIEP flap surgery is usually shorter. DIEP flap surgery does not remove abdominal muscle, while TRAM flap surgery removes some or all of this muscle.
Some surgeons can reconnect sensory nerves in the flap to nerves in the chest, which may help restore sensation in the breast. However, the amount of sensation that returns varies from person to person.
Because DIEP flap reconstruction uses your own fat tissue, the reconstructed breast can change with your body over time. Weight gain after DIEP flap reconstruction may increase the breast’s size, while weight loss may make it smaller.
Like any surgery, DIEP flap breast reconstruction has possible risks and complications, such as necrosis (tissue death), hernia, and fluid buildup.
Tissue flap necrosis happens when part or all of the transferred tissue doesn’t get enough blood and dies. The tissue may become blue or black or feel cool to the touch.
If a small area of tissue dies, a surgeon may remove the dead tissue. In rare cases, most or all of the flap develops necrosis and the entire flap must be removed.
Fat necrosis happens when some of the fat in the flap doesn’t get enough blood and is replaced by firm scar tissue. This can cause a lump in the reconstructed breast, often around six to eight months after surgery.
Fat necrosis isn’t cancer, and smaller areas may go away on their own. However, tell your doctor about any new breast lump so they can determine the cause.
A hernia occurs when a hole or weak area develops in the abdominal wall so that part of an organ, such as the intestine, bulges out. The risk is small after DIEP flap reconstruction because the procedure does not remove abdominal muscle.
Sometimes, swelling around the abdomen can create a bulge that some MyBCTeam members have said reminds them of a Ken doll.
Swelling around the abdomen and reconstructed breast is common for a few weeks after DIEP flap surgery. Sometimes, a pocket of fluid called a seroma can develop under the skin. A bulge may also be related to abdominal wall weakness or a hernia.
After surgery, you’ll likely have a hospital stay of two to four days. Before you leave, your surgical team will explain how to care for your incisions, dressings, and drains at home.
Recovery from a DIEP flap can take six to eight weeks. Soreness and swelling around the breasts and abdomen can last for a few weeks. Numbness may continue up to a year.
Some people also report feelings of tightness. One MyBCTeam member said, “Your tummy is very tight after surgery, so sleeping flat is impossible. I even tucked a few pillows under my knees to be comfy.”
Recovery time is different for everyone and may take longer for some. “Now that I am six months out from my reconstruction, I am feeling great!” another member said. “My abdominal area is still a little tender, but I am completely back to all my activities.”
Some people choose to have additional procedures after they heal to improve the shape or symmetry of the reconstructed breast or make other changes. In one study of 104 people who completed a survey after DIEP flap reconstruction, 92 percent of participants who had DIEP flap reconstruction were satisfied with the results.
If you’re considering DIEP flap breast reconstructive surgery, talk with your doctor. They’ll know if you’re a good candidate and will be able to recommend a qualified plastic surgeon. If you have the procedure, follow your surgical team’s instructions about when to contact them during recovery.
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My diep flap breast is quite a bit smaller than my non reconstructed breast, I had lots of fat in my abdomen.
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Update! The surgery had to be rescheduled so I would have enough time to pause my abemaciclib (Verzenio). Bonus was getting both thd left and right side reconstructed at the same time. DIEP flap on… read more
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