Breast reconstruction following a mastectomy offers advanced options, including the DIEP flap procedure. This technique uses a woman’s own tissue to rebuild the breast, providing a natural result with reduced impact on core strength. Understanding the details of this sophisticated surgery helps patients make informed choices about post-mastectomy care.
Defining the DIEP Flap Procedure
The acronym DIEP stands for Deep Inferior Epigastric Perforator, named after the specific blood vessel used to keep the transplanted tissue alive. A “flap” is a section of tissue—skin, fat, and blood vessels—removed from the lower abdomen and transferred to reconstruct the breast mound.
A perforator is a small blood vessel that branches off a larger, deeper vessel and passes through the muscle to supply the skin and fat. The defining characteristic of the DIEP flap is the meticulous separation of this blood vessel from the surrounding rectus abdominis muscle, the major core muscle. This careful dissection allows the surgeon to harvest the necessary skin and fat while preserving the abdominal muscle itself.
This muscle-sparing approach distinguishes the DIEP flap from older tissue reconstruction methods. The goal is to transfer the soft, natural tissue needed for the new breast while leaving the abdominal wall intact to maintain strength and function. The tissue harvested from the abdomen is identical to the tissue removed during a cosmetic tummy tuck, which provides a secondary contouring benefit at the donor site.
The Surgical Process and Immediate Recovery
The DIEP flap procedure involves two simultaneous surgical teams working on separate sites: the chest (recipient site) and the lower abdomen (donor site). The abdominal team isolates the skin, fat, and specific perforator blood vessels to create the tissue flap. The chest team prepares the mastectomy site and identifies the blood vessels that will receive the flap’s circulation.
The surgery relies on microsurgery, which involves connecting the tiny blood vessels of the flap to the vessels in the chest under high magnification. This re-establishment of blood flow is necessary for the flap to survive and become living tissue in its new location. The procedure is lengthy, often requiring four to eight hours, depending on whether one or both breasts are being reconstructed.
Following surgery, patients typically remain in the hospital for two to five days. The surgical team closely monitors the flap during the initial days to ensure it is receiving adequate blood supply. Patients are encouraged to begin walking within 24 to 48 hours to promote circulation and lung health.
Immediate recovery involves managing pain and caring for surgical drains placed at both sites to collect fluid. Patients are advised to avoid strenuous activities, heavy lifting, and overhead movements for at least four to six weeks. While full recovery can take up to eight weeks, patients often return to work or light activities within two to four weeks.
Key Advantages Over Other Reconstruction Methods
The primary benefit of the DIEP flap procedure is its muscle-sparing nature, offering a significant advantage over the older Transverse Rectus Abdominis Myocutaneous (TRAM) flap. The TRAM flap required removing a portion of the rectus abdominis muscle, resulting in a weakened abdominal wall and a higher risk of hernia. By preserving the muscle, the DIEP flap minimizes the risk of abdominal weakness, bulging, and hernia formation at the donor site.
This preservation of core strength translates into a faster and less painful recovery for the patient. The DIEP flap is associated with lower rates of abdominal wall hernias compared to the TRAM flap, as the structural integrity of the abdomen is maintained. Patients undergoing DIEP reconstruction often return to their normal physical activities sooner and with less long-term discomfort than those who had older muscle-sacrificing methods.
Another advantage is the long-lasting quality of the reconstructed breast. The new breast is created using the patient’s own living tissue, which is warm, soft, and feels more natural than a breast implant. This tissue ages naturally with the body, eliminating the long-term maintenance, potential rupture, or hardening that can occur with silicone or saline implants. Furthermore, the DIEP flap is often a one-time procedure, unlike implants which may require replacement surgeries ten to fifteen years later.
Patient Eligibility and Specific Risks
A patient’s candidacy for DIEP flap reconstruction is determined by their overall health and the availability of suitable donor tissue. There must be sufficient excess skin and fat in the lower abdomen to create the desired breast size. While the procedure is possible for thin women, those with minimal abdominal tissue may require alternative approaches.
Patients must be medically fit to undergo a lengthy and complex operation requiring general anesthesia. Smoking is a contraindication because nicotine constricts blood vessels, increasing the risk of complications like flap failure and poor wound healing. Certain pre-existing health conditions, such as uncontrolled diabetes or severe heart or lung problems, may also increase the surgical risk.
The DIEP flap is a complex microsurgical procedure that carries specific risks beyond those of general surgery. The most serious risk is flap failure, which occurs if the blood vessel connections clot or fail, leading to tissue death (necrosis). This complication happens in a small percentage of cases and requires emergency surgery to remove the non-viable tissue.
Another potential complication is fat necrosis, where fat cells in the flap do not receive adequate blood supply and die, forming firm, benign lumps. While the risk of abdominal wall hernia is low compared to older techniques, it remains a possibility. Surgeons must also assess for previous abdominal procedures, such as a tummy tuck or certain hernia repairs, which may have compromised the necessary blood vessels, potentially ruling out the DIEP flap option.