Choosing DIEP flap breast reconstruction surgery

Breast reconstruction can be a key part of the healing process for patients undergoing a mastectomy due to breast cancer or other conditions. Among the various breast reconstruction options available, DIEP flap breast reconstruction surgery is a complex and highly personalised procedure that can provide natural-looking results.

This article explores what the DIEP flap procedure entails, the risks involved, the recovery process, and the expected outcomes.

Can DIEP flap breast reconstruction surgery be done immediately after a mastectomy?

Yes, DIEP flap breast reconstruction surgery can be performed immediately after a mastectomy, which is a process known as immediate reconstruction. In this case, the reconstruction is done at the same time as the mastectomy, avoiding the need for a second surgery.

Immediate reconstruction can be beneficial, but it’s important to know that not everyone is a candidate. Factors such as the need for further cancer treatments, like radiation, and the patient’s overall health may lead to a recommendation for delayed reconstruction, which occurs months or even years after the mastectomy.

How is DIEP flap breast reconstruction surgery performed?

DIEP stands for deep inferior epigastric perforator flap. In this procedure, the surgeon will take skin, fat, and blood vessels (but not the underlying muscle) from the lower abdomen to create a new breast mound.

During DIEP flap breast reconstruction, the surgeon will first make an incision along the lower abdomen. Skin, fat, and the necessary blood vessels will be removed from the abdomen, while preserving the abdominal muscles, helping to minimise long-term damage to the core muscles.

The surgeon will then relocate the abdominal tissue (known as the flap) to the chest area. Subsequently, microsurgery will be performed to carefully reconnect the blood vessels from the flap to the blood vessels in the chest area (such as the internal mammary or thoracodorsal arteries). This will ensure the flap receives adequate blood supply to survive.

Once the flap is secured, the surgeon will reshape the flap to create a natural-looking breast. If only one breast is being reconstructed, the opposite breast might also undergo surgery (such as a breast lift or reduction) to achieve better symmetry.

After the tissue has been shaped, the incisions on the abdomen and chest will be closed. The result in the abdomen will be similar to a tummy tuck, as excess skin and fat will be removed, leading to a smoother, flatter appearance.

The whole procedure will last between 6 to 10 hours, depending on whether one or both breasts are being reconstructed.

What are the risks or potential complications associated with DIEP flap breast reconstruction surgery?

Like any major surgery, DIEP flap breast reconstruction surgery comes with potential risks and complications.

Initially, the breast(s) will feel numb as the nerves were severed during the surgery. Some patients may regain partial sensation over time as nerves slowly regenerate, but full sensation may not return in some cases.

Infections can also occur at the incision sites, especially in the abdominal or breast areas. Additionally, there is a risk of developing blood clots, especially in the legs or lungs.

In rare cases, the flap may not receive sufficient blood supply, which can cause the tissue to fail. This may require additional surgery to either correct the issue or remove the flap entirely.

What is recovery like after DIEP flap breast reconstruction surgery?

The recovery time after DIEP flap breast reconstruction surgery is generally longer compared to implant-based reconstructions due to the complex nature of the surgery and the dual surgical sites (abdomen and chest).

Most patients will spend 3 to 5 days in the hospital. During this time, the surgeon and the nurses will monitor the flap to ensure proper blood flow. Once at home, patients may experience swelling, bruising, and discomfort in both the abdomen and breast areas during the first few weeks.

Most patients will be able to resume their normal activities, including work, after 6 weeks. However, it’s important to avoid intense physical activities and heavy lifting for at least 8 weeks to prevent injury to the abdominal area.

Will my reconstructed breast(s) look and feel natural?

One of the primary benefits of DIEP flap breast reconstruction surgery is that it uses the patient’s own tissue. This means that the reconstructed breast will be shaped to resemble the original breast, which often leads to a more natural look and feel compared to silicone or saline implants.

Since the reconstructed breast will be made of natural fat, it will also feel soft and warm, much like the original breast. Over time, the tissue will age along with the rest of the body, so the breast will change naturally.