What Are the Benefits of DIEP Flap Breast Reconstruction Surgery?

Flap surgery is when doctors move healthy tissue from one part of the body to another, usually to reconstruct an area that has been damaged or removed due to disease or trauma.

While a majority of breast reconstruction is done using implants, some cancer patients undergoing mastectomies are candidates for reconstruction using their own tissue.  A natural-tissue breast reconstruction can come from a variety of donor sites on the body, including: the lower abdomen, inner thigh, back or buttocks.

The most common of these procedures is the deep inferior epigastric perforator (DIEP) flap. It involves using a flap of tissue removed from the lower belly and transferred to the chest.  This can be done to rebuild one or both breasts and can also be done at the time of mastectomy (immediate) or in a delayed fashion.

The American Society of Plastic Surgeons refers to DIEP flap surgery as “today's most advanced form of breast reconstruction” and is widely regarded as the gold standard breast reconstruction.   

Is DIEP flap a major surgery?

DIEP flap surgery is a long, complex, microsurgical procedure that requires a multi-day hospital stay. Breast implant reconstruction, on the other hand, is often done as an outpatient procedure.

Most patients need at least six weeks of recovery time before resuming normal activities. Although this surgery involves two surgical sites (breast and abdomen) recovery is similar to implant-based reconstruction and most patients return to work in a similar amount of time. 

Potential complications associated with DIEP surgery include wound healing issues, blood clots, hardened lumps in the breast, infection, hematomas, abdominal muscle weakness and other doner site issues.

DIEP flap surgery can offer several advantages over implants, including a more natural look and feel. Most patients have revision surgery about six months later for cosmetic refinements. Flap reconstruction generally lasts a lifetime, while most patients with implants tend to have revision surgery every 10-20 years. 

What happens during DIEP flap surgery?

DIEP flap surgeons transplant skin, fat and blood vessels from the lower abdomen to rebuild the breast after mastectomy. This is done carefully so as not to remove any abdominal muscle.

The doctors typically make an incision in the lower abdomen stretching from hip-to-hip. They then dissect free lower abdominal skin and fat (similar to a tummy tuck) while working carefully to remove the small vessels that will supply the transplanted tissue with blood flow. 

During the highly specialized microsurgical operation, surgeons use a microscope to reconnect the transplanted blood vessels. The success of the procedure requires a flawless reconnection of the vessels. Despite all of this, DIEP flaps are generally 97%-99% successful. 

Is DIEP flap like a tummy tuck?

Both procedures remove excess skin from the lower belly and leave similar scars. And both result in a flatter abdomen. The improved belly shape can be a rewarding benefit for women who need to undergo mastectomy. 

However, the goal of the DIEP is to restore the breast so there are some differences. DIEP flap surgery may involve a slightly higher scar position and does not include liposuction at the first stage. A tummy tuck is a cosmetic procedure done solely to improve body contour and typically includes liposuction.

Will my stomach be flat after DIEP flap surgery?

Your abdomen will be smaller after a DIEP flap. The surgery takes out extra fat under the skin, but it doesn’t necessarily remove the fat that sits in the upper abdomen or deep inside the belly. That deep fat can still leave a rounded upper belly shape in some patients. 

The patient’s post-operative shape will depend to a large degree on body type. Further improvements to the abdomen with liposuction and scar revision are common at the second stage revision surgery.

Do you lose weight after DIEP flap surgery?

The net weight change after removing tissue from one part of the body and immediately putting it in another place is minimal. Sometimes, fluid buildup from the surgery can temporarily increase a patient’s weight.

It’s important to know that the tissue used in the reconstruction acts like normal fat. If the patient loses or gains weight years after flap surgery, the reconstructed breasts can shrink or grow right along with those body changes. This is one advantage of flap reconstruction over an implant, because it will change naturally with your body overtime.

What do you wear after DIEP flap surgery?

Patients who undergo DIEP flap surgery are commonly placed in a supportive bra and an abdominal compression garment (like an abdominal binder or a girdle). These provide support and can also help with post-op swelling and long-term shape.

 Loose-fitting clothing is often helpful in the early recovery period.

Who is not a good candidate for DIEP flap surgery?

Some women are not interested in the added surgery time, a hospital admission, have a tissue donor site, or larger recovery.

This invasive surgery may be unsafe for patients with health conditions like heart or lung problems, a history of pulmonary embolism, or deep vein thrombosis.

Other factors that may prevent patients from that flap surgery include:

• Having had certain abdominal surgeries, such as ventral hernia repair, laparotomy, liposuction, or tummy tuck in the past.
• Cases where the patient’s abdominal blood vessels are too small or aren’t in the best location to do a DIEP flap.
• A desire to avoid the potential complications that are associated with DIEP flap surgery.
• Smokers are generally not good candidates because nicotine harms small blood vessels and healing.

What are the eligibility criteria for DIEP flap surgery?

Those wishing to have the surgery should have good overall health to tolerate the long microsurgery, a stable weight, sufficient lower abdominal tissue and a desire to avoid implants.

Learn more about expert breast reconstruction surgery at Ochsner.