DIEP Flap (Deep Inferior Epigastric Artery Perforator Flap)
The DIEP Flap (Deep Inferior Epigastric Artery Perforator Flap) is a modification of the TRAM flap ( transverse rectus abdominus myocutaneous flap) for breast reconstruction. The DIEP flap provides autologous (self-derived tissue) skin and fat from the lower abdomen to reconstruct the breast. This form of breast reconstruction provides a natural look and feel as it replaces breast tissue removed during mastectomy with skin and fatty tissue, replacing “like with like.”
The DIEP flap has improvements over the traditional TRAM flap in that it does not require taking the rectus abdominus muscle from the abdomen. Therefore the abdominal muscles are not weakened and there is less risk for development of a postoperative hernia. Unlike implant-based reconstruction, the DIEP flap is autologous tissue therefore it is not prone to infection, capsular contracture, or need for replacement.
Breast reconstruction with the DIEP does require the patient to have some excess skin and fatty tissue at the lower abdomen. Therefore not all patients are candidates for DIEP flap breast reconstruction. Additionally, the DIEP flap is a form of microsurgery requiring free tissue transfer and longer operative time and recovery than other forms of breast reconstruction. Patients with significant medical problems may not be candidates for DIEP flap reconstruction due to longer operative and recovery times, as well as higher risk for complications.
- Natural breast shape, behavior and consistency
- Similar to a “Tummy-Tuck” and spares the rectus muscle
- No foreign body
- Long-term lower costs and less emotional trauma
- Longer surgical procedure, hospitalization and recovery
- Additional scarring and possible complications
Some patients require removal of the nipple to treat their cancer. In these situations skin from the DIEP flap is used for nipple and areola reconstruction. Secondary procedures include:
- Breast mound reshaping
- Nipple reconstruction
- Nipple areolar tattoo or micropigmentation
Advantages of DIEP Flap
- Minimal to no muscle taken with the flap, reducing the potential for functional impairment postoperatively.
- The abdominal scar can be hidden in a lower position because the skin island can be designed lower in the abdomen.
- A better shape of the new breast can be achieved (without fullness across the chest from the tunneled muscle, which is pedicled)
Effects of Smoking, Tobacco, and Nicotine
The use of tobacco and nicotine products has negative effects following any kind of operation, especially breast reconstruction. Smokers experience increased wound healing problems like slowed healing or no healing at all when compared to non-smokers. To decrease risk of wound healing problems the active smoker should stop smoking five weeks before the first stage operation and well after she’s completely healed.
The days before surgery, a urine test may be performed to assure nicotine blood levels have returned to normal.
The Abdomen After DIEP Flap
Women diagnosed with early stage breast cancer are good candidates for lumpectomy with radiation. Lumpectomy is considered “Breast Conservation” therapy, where the goal is to remove only the tumor while sparing the remaining healthy breast tissue.
Unfortunately, the risks of lumpectomy include unexpected scarring and breast asymmetry. These risks are mainly due to the effects of the required radiation.