Delayed Diep Flap Reconstruction

Using Abdominal Fat and Skin

(DIEP Flap Reconstruction- Deep Inferior Epigastric Perforator)

The DIEP flap is regarded as the gold standard procedure for breast reconstruction. This method of reconstruction when used for a delayed reconstruction that is some time after the mastectomy uses skin and fatty tissue from the abdomen to restore the breast. The abdominal skin becomes the breast skin. The abdominal tissue used to rebuild the breast is reattached via blood vessels using microsurgery. The result in the abdomen is similar to that of a tummy tuck meaning that the abdominal contour is usually improved as well. One huge advantage of the DIEP procedure is that it does not affect the muscles of the abdomen.

Several days before the operation the patient will have an anaesthetic assessment to establish that they are fit for the lengthy procedure. This will take into account the patients medical history and their general health.

A CT scan is always carried out prior to surgery. This is used to visualise and assess the flow patterns of arteries and veins and provides information about the best place to the take the tissue from before the operation begins.

There are ‘pros’ and ‘cons’ to this surgery. To help give you an overview the main ones are listed below.

Pros

Uses your own tissue (fat) which means that your new breast will usually closely resemble the normal breast in texture and movement and in shape and ‘fall’.
The reconstructed breast will change with the opposite breast If you put on weight the breast will increase in size and similarly a loss of weight will mean the breast will reduce – it will alter and age as you alter and age in shape and size as it is living tissue.
This form of reconstruction usually improves over time.
Can leave the patient with a flatter tummy.
Abdominal muscle is left intact, only fatty tissue is taken from donor site
One main operation.

Cons

A typical unilateral reconstruction operation, lasts usually 4 hours of surgery including the mastectomy and a 4 night hospital stay.
The flap is monitored every hour for the first three days. There is a small risk of failure of the flap at this stage and this could result in emergency surgery.
2 month recovery period.
There will be an abdominal scar similar to that following a ‘tummy tuck’ or a ‘caesarean scar’.

FACTS AT A GLANCE

Surgery time	4 Hours
Hospital stay	4 Days
Anaesthetic assessment	Yes, you will meet the anaesthetist prior to surgery
Confined to bed	1 Day
Up and walking	Next day
Reasonably mobile	1 week
Full recovery	6 – 8 weeks
Time off work	6 weeks
Bras and garments	Abdominal binder and bra worn for 2 weeks
Possible reconstruction issues	Failure rate of less than 0.5% i.e. 1 in 200
Long term issues	None
Secondary surgery	Nipple reconstruction. Possible liposuction and/or auto fat injections. Possible surgery to opposite side to achieve symmetry.ONLY IF YOU WANT IT. THE FIRST SURGERY WILL MAKE 95% NORMAL.