Breast Reconstruction: DIEP Flap

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A Deep Inferior Epigastric Perforator (DIEP) flap is a type of breast reconstruction where skin, fat and blood vessels from the lower abdomen are removed and transplanted to the chest, creating a new “breast” after mastectomy. It is slightly different than a TRAM (Trans Rectus Abdominis Muscle) flap because DIEP flap does not include a patient’s muscles. This makes for a more functional long-term outcome with less risk of abdominal hernia or bulge and ability to maintain “core” muscles.

DIEP flap and other tissue-based reconstructions can give a more natural appearance to the reconstructed breast than implants. The tissue will gain and lose weight with the patient. It is many times the preferred option over implant-based reconstruction for breast cancer patients that have had radiation. Many patients also look favorably upon the idea of removing excess lower abdominal tissue. Patients with tissue-based reconstruction have been found to be statistically more satisfied over time than patients receiving implant based reconstruction.

DIEP flap surgery does require a longer time under anesthesia than other types of breast reconstruction (at least 4-6 hours per reconstructed breast). The surgery is done partially under a microscope to re-connect blood vessels that are 3-5mm in size. Recovery typically involves a 2-5 day hospitalization followed by 4-8 weeks of recovery at home. Risks are similar to other tissue based breast reconstructions. These include: loss of flap due to poor blood flow, infection, wound healing problems, and need for further operations. 

Deciding what kind of breast reconstruction to choose is a complicated process that requires individualization to the patient’s personal health, breast cancer treatment plan, and preferences with the guidance of an experienced reconstructive plastic surgeon.  Using a woman’s own tissue to reconstruct her breast(s) with a DIEP flap(s) is a reliable, safe and durable reconstructive option, especially for women who want longevity from their breast reconstruction or may require radiation therapy to treat their breast cancer.  

Typically, surgeons that perform DIEP flaps are plastic surgeons that specialize in micro-vascular surgery. They have done special training with the microscope doing breast reconstruction as well as other types of “free flaps,” where they are re-attaching small blood vessels on a regular basis. Ask your breast surgical oncologist for recommendations in your area. 

References:

Albornoz CR, Matros E, McCarthy CM et al. Implant breast reconstruction and radiation: A multicenter analysis of long-term health-related quality of life and satisfaction. Ann Surg Oncol 21: 2159-64, 2014 https://www.ncbi.nlm.nih.gov/pubmed/24740825

Sgarzani R, Negosanti L, Morselli P, et al. Patient satisfaction and quality of life in DIEAP flap versus implant breast reconstruction. Surg Res Pract. 2015: Nov 16. https://www.hindawi.com/journals/srp/2015/405163/

Yueh JH, Slavin SA, Adesiyun T et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus and implant techniques. Plast Recon Surg, 125(6): 2010, 1585–95. https://www.ncbi.nlm.nih.gov/pubmed/201517080

Pirro O, Mestak O, Vindigni V, et al. Comparison of patient-reported outcomes after implant versus autologous tissue reconstruction using the BREAST-Q. Plast Recon Surg Glob Open. 2017; 5: e1217. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293311/

Selber JC, Nelson J, Fosnot J, et al. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: Part I. Unilateral reconstruction. Plast Recon Surg. 2010;126: 1142–1153.  https://www.ncbi.nlm.nih.gov/pubmed/20885239

Selber JC, Fosnot J, Nelson J, et al. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: Part II. Bilateral reconstruction. Plast Recon Surg. 2010; 126: 1438–1453. https://www.ncbi.nlm.nih.gov/pubmed/21042100