What is DIEP flap breast reconstruction and is it right for me?

Women who undergo a mastectomy may be faced with difficult choices around the time of their surgery. How important are my breasts to me? Should I use prosthetics? Do I want to undergo more surgery? Which type is right for me? Of those who choose breast reconstruction surgery, many are choosing DIEP flaps for the long-term benefits over implants. In the first of three articles Mr Kelvin Ramsey - an expert plastic surgeon who has performed more than 500 DIEP flap operations - explains more to help you decide if they are right for you.

What is a DIEP Flap?

A DIEP flap, or a Deep Inferior Epigastric Perforator flap, to give it its full name, is a piece of tissue (flap) taken from the tummy (abdomen), which is then used to make a new breast. The tissue and its blood vessels are detached and then reconnected to a new blood supply in the chest.

Why choose a DIEP Flap operation?

If you choose to have breast reconstruction surgery following a mastectomy, DIEP Flap procedure can produce much more natural looking and feeling breasts than implants.

By utilising spare living tissue, the procedure results in soft, warm and pliable breasts that closely resemble natural breasts. It is for this reason that DIEP flaps are considered the gold standard for breast reconstruction.

For many women, the removal of tissue from the abdomen is a welcome aspect of the procedure as it results in a flatter stomach.

As no abdominal muscle is removed or transferred to the breast area, there is usually less post-operative pain and a shorter recovery time than many other flap procedures.

How is the breast reconstructed?

The tissue, or DIEP flap, is carefully removed from the abdomen. Microsurgery is then used to reconnect it to the chest before the surgeon begins to shape the new breast. The operation is complex and the whole procedure takes approximately 5 to 7 hours.

Will more surgery be required?

Most breast reconstruction surgery requires two or more operations. As much of the reconstruction as is possible is done at the time of the main operation, but there is often a need for a second, smaller operation. This might be to refine and adjust the reconstruction or to remake the nipple.

The result of the operation, however, should be life-long, which is one of the great advantages of DIEP flaps. In addition, the reconstruction should age with you naturally and change with your body weight. Implant-based reconstructions are obviously unable to do this and they frequently need revision surgery.

Is it suitable for me?

Generally speaking, DIEP flaps are a good option if you don’t want implants and have enough spare tissue around the abdomen. The procedure may also be possible even if even you have had abdominal surgery, unless the scarring is particularly severe. 

DIEP flaps might not be viable if you are very slim or very overweight. Additionally, if you smoke or have health complications like diabetes, they may not be suitable for you. Mr Ramsay will discuss your situation and whether or not the treatment is right for you.