Understanding DIEP Flap Breast Reconstruction: A Natural Choice

What is a DIEP flap procedure?

DIEP (pronounced like deep) flap is a type of reconstruction that uses a woman’s own tissue to create a new breast after a mastectomy. The surgery’s name comes from the branches of the primary blood vessel relocated during the procedure, the deep inferior epigastric perforator (DIEP).

DIEP flap breast reconstruction surgery is relatively new to the world of plastic surgery, and few health care facilities have the expertise necessary to perform the surgery safely. Yet due to its significant benefits, DIEP is quickly becoming known as the state-of-the-art choice for breast cancer patients.

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How does it work?

DIEP flap surgery uses a flap of complete tissue – blood vessels (perforators), skin and fat – from a woman’s lower abdomen as donor tissue. After the DIEP flap has been taken from the abdomen, the dissected blood vessels from the belly tissue are then connected to the patient’s chest blood vessels. The flap is then transferred to the chest where the surgeon, aided by a microscope, will attach the donor tissue blood vessels to the chest blood vessels and reconstruct the breast. Studies have shown that this aspect of the DIEP procedure, which requires a long period of delicate microsurgery, can lead to a better blood supply for the transplanted tissue, and thus, less fat necrosis (tissue damage). Once the vessels have been attached, the surgeon works on shaping the breast. 

View the DIEP Diagram Courtesy of American Cancer Society

What are the benefits?

The DIEP procedure keeps the muscle in place on the abdomen so that it may continue to perform its intended functions. By maintaining the viability of the abdominal muscle, the DIEP procedure helps to preserve abdominal strength, lessen the likelihood of a hernia and shorten recovery time.

This delicate procedure provides significant benefits, such as a slimmer appearance, a natural-looking breast, maintained core strength and a quick recovery. Not every woman is a candidate for this type of breast reconstruction, and it is best to discuss the pros and cons of these procedures with your surgeon.

Meet Beth!
She did Diep Flap and is very pleased with her results.

Hi there! My name is Beth, and I was diagnosed with stage 3 Triple Negative Breast Cancer in 2018 at just 32 years old. After about two years’ worth of treatment including a double mastectomy, chemo, radiation, and DIEP flap reconstruction, I’m figuring out how to navigate this life after a cancer diagnosis. I feel insanely blessed to be where I am today, and to have met so many amazing fellow survivors. My diagnosis has inspired me to live life to the fullest!

Play Video about Beth Headshot

What to expect?

DIEP flap reconstruction surgery takes about 6 to 8 hours. After, you will be moved to a recovery room where hospital staff members will monitor your heart rate, body temperature, and blood pressure. You’ll then be admitted to a hospital room. For a DIEP flap procedure, a typical hospital stay is about 5 days.

Recovery may take about 6 to 8 weeks. Your doctor may recommend that you wear a compression girdle for up to 8 weeks after surgery. Because you’ve had surgery at two sites on your body (your chest and your belly), you might feel worse than someone having mastectomy alone and it will probably take you longer to recover. You’ll likely have to take care of multiple incisions: on your breast(s), your lower abdomen, and around your belly button, and you’ll probably have drains in your reconstructed breast(s) and in your abdominal donor site.

It sometimes takes as long as a year or more for your tissue to completely heal and for your scars to fade, and you may decide to have additional “finishing” work done, such as reshaping the flap or reconstructing a nipple.

Am I a candidate for a DIEP flap procedure?

Most women with adequate skin and fat of the lower abdomen are candidates for DIEP flap reconstruction. For a unilateral (single) mastectomy, the entire flap can be used, while a bilateral (double) mastectomy reconstruction requires the harvested flap to be split to restore each side.

Prior to surgery, a special CT or MRI scan (angiogram) is performed to evaluate where the best blood vessels are located. Visualization of the specific type of blood vessels helps to make the selection of the “right” perforator (blood supply vessels) during the operation easier. This test confirms that a patient is a good candidate for the surgery. Finally, the imaging also reduces operating time.

How to Find a Qualified Plastic Surgeon

In some cases, a plastic surgeon may be “assigned” or recommended to you as part of your treatment team. In other cases, you may need to find a plastic surgeon on your own. Whatever your situation, you’ll want to interview any surgeon who is recommended to make sure you’re comfortable with his or her surgical expertise and communication skills. Plastic surgeons who offer breast reconstruction vary widely in their level of skill and the range of procedures they can perform. Newer flap procedures, such as the DIEP flap, require special skill and training in microsurgery, which involves reattaching tiny blood vessels from the flap tissue to the vessels in the chest area.

There are many questions to ask during your consultation, below are a few to consider:

  • What type of breast reconstruction is best for me?
  • How many reconstruction procedures have you done?
  • Which types of reconstruction are you most experienced in?
  • Do you have photos of similar reconstructions that you’ve performed?
  • What results are realistic for me?
  • How will my reconstructed breast feel to the touch?
  • Will I have any feeling in my reconstructed breast?
  • Can you connect me with other women who have had the same surgery?
  • Are there any new reconstruction options that I should know about?

Don’t feel the need to make your decision immediately. Consider your options, research, and meet with several surgeons if necessary.

Dr. Ron Israeli Headshot with a red rose as background

Dr. Ron Israeli

Plastic Surgeon, LLL Medical Advisor

“The gold standard approach to natural tissue breast reconstruction is the DIEP flap. Spreading awareness of the DIEP flap option will help assure that all women who are candidates for this approach will have access to surgeons who are experts in microsurgery. The Learn Look Locate platform helps spread the word, empowering women to understand all their breast reconstruction options.”

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