DIEP Flap Surgery

Overview

DIEP flap surgery is a form of breast reconstruction that utilizes the deep inferior epigastric perforator (DIEP) artery, a blood vessel located in the lower abdomen. During this procedure, a surgeon reconstructs the breast by using skin, fat, and blood vessels from the patient’s lower belly.

As a muscle-sparing procedure, DIEP flap surgery does not involve cutting or removing any abdominal muscles. In contrast, other techniques like TRAM (transverse rectus abdominis muscle) flap surgery require taking muscle from the belly or other body areas, leading to a longer recovery process.

Reasons for undergoing the procedure

DIEP flap surgery is a breast reconstruction method used following breast cancer surgery. This procedure can be chosen after a mastectomy (complete breast removal) or a lumpectomy (partial breast removal). DIEP flap surgery may be performed concurrently with the breast cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction).

Opting for breast reconstruction is a personal decision. Individuals may choose this option for various reasons, including:

• Give their chests a more proportionate appearance.
• Enhance the fit of clothing.
• Raise their sense of self-esteem.

Risks

Although they are uncommon, DIEP flap surgery complications can include:

• Hernia: Occasionally, a portion of the intestine may protrude through a weakened area in the abdominal muscles post-surgery.
• Lumps: Firm scar tissue might develop in the reconstructed breast, creating a lump. This lump may resolve on its own or can be removed by your surgeon.
• Necrosis: If the transferred flap does not receive sufficient blood supply, some tissue may die, turning black and feeling cold. Your surgeon will need to remove the dead tissue. In rare cases, the entire flap may develop necrosis and require removal.

Before the procedure

Your doctor will give you specific guidelines for preparing for DIEP flap surgery. This may involve a thorough physical exam and lab tests to confirm your suitability for the procedure. They may also take photographs of your breasts and abdomen and request imaging scans to assist in planning the surgery.
In addition, you should:

• Increase cardiovascular health and muscle strength by engaging in mild exercise in the weeks and months leading up to surgery.
• Give up taking some medications, like aspirin and Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
• Give up smoking and stay away from all nicotine-containing products.

During the procedure

DIEP flap surgery typically lasts between six to eight hours, duration varying based on whether the reconstruction is immediate or delayed. In cases of delayed reconstruction, a tissue expander may have been previously inserted under the chest skin post-mastectomy, which will be removed during the flap surgery.

In general, you can expect the following steps:

• Anesthesia: You will receive anesthesia intravenously to ensure you are asleep and pain-free during the procedure.
• Incision: The surgeon will make a long incision across your lower abdomen, from hip bone to hip bone, located between your belly button and the beginning of your pubic hair.
• Tissue Removal: A flap of skin, along with fat and blood vessels, will be taken from your abdomen without removing any muscle.
• Tissue Transfer: An incision will be made in your chest, usually along the same line as your mastectomy or lumpectomy scar. The flap will then be transferred to the breast area, and the surgeon will connect the blood vessels from the flap to those in your chest.
• Breast Shaping: After the blood vessels are connected, the surgeon will shape the tissue to resemble the natural breast contour.
• Drain Placement: Drains will likely be placed in both the abdominal and chest incisions to remove fluid, minimize swelling, and aid in recovery. These drains will be removed a few weeks after surgery.
• Closure: The surgeon will close the incisions in your chest and abdomen using stitches or staples, positioning the abdominal skin so that your navel remains in a natural location.

After the procedure

Following DIEP flap surgery, you will remain in the hospital for two to five days. Your doctor will give you comprehensive instructions on:

• How to empty drains and take care of your incision at home.
• Drugs to take and stay away from.
• What types of clothing to choose.
• The ideal time to resume regular activities.

Outcome

After undergoing DIEP flap surgery, recovery typically spans six to eight weeks. During the initial weeks, your surgeon may recommend wearing a compression garment over your chest or abdomen. It’s important to avoid strenuous activities, heavy lifting, and overhead movements during this period. By the second week, your surgeon may suggest beginning mild exercises or arm movements as part of your recovery plan.

Expect the following after surgery:

• Numbness in the abdomen and reconstructed breast, which may persist for up to a year.
• Pain and soreness in the chest and abdomen, gradually improving over two weeks or longer.
• Swelling around your abdomen, underarms, and reconstructed breast for a few weeks.
• Tightness in the skin around the repaired breast and abdomen.