DIEP flap breast reconstruction

About DIEP flap breast reconstruction

You’ve had a consultation with your plastic surgeon during which he/she discussed the possibilities of a breast reconstruction. Here you will find additional information regarding a DIEP flap breast reconstruction.

Hier vindt u de Nederlandse informatie over de DIEP lap borstreconstructie.

What is a DIEP flap?

DIEP stands for Deep Inferior Epigastric artery Perforator. The procedure is named after a blood vessel that supplies blood to the tissue of the abdomen that is being used to reconstruct the breast. With this type of transplantation, the deeper abdominal muscles will be preserved.

The DIEP flap technique is particularly suitable for women who would like a reconstruction with their own tissue without the use of silicone implants. A DIEP flap breast reconstruction is suitable for the reconstruction of one or both breasts.

The flap, existing of skin, fatty tissue and blood vessels, will be removed from the abdomen and transferred to the breast. Following this, the blood vessels of the flap will be connected to the blood vessels in your chest.

After blood flow has been restored and checked, the flap will be remodelled to a breast which closely resembles your other breast. The abdomen will be closed and the belly button will be replaced and sutured in the correct spot. The result will resemble a tummy tuck.

The skin of your breast will show scars of the mastectomy and reconstruction.

The scar on your lower abdomen will be positioned as low as possible, preferably below the line of your underwear. The operation will take between 7-10 hours.

What are the benefits and disadvantages of a DIEP flap procedure?

Benefits:

• The newly shaped breast is soft and will look much more natural over time compared to an implant based reconstruction.
• Since your own tissue will be used, there is a lower chance on delayed complications (such as capsular contracture with silicone implants).
• Your own tissue will be used, which will fluctuate naturally with aging and weight gain or loss.
• The result of the abdominal procedure resembles a cosmetic procedure.

Disadvantages:

• The procedure is complex and takes long. You will probably have to stay in the hospital for around 4-5 days.
• The recovery of this operation is longer than with an implant. The period you are not able to work will also be longer compared to an implant based reconstruction (approx. 6 weeks).
• You will have an additional scar on your lower abdomen. You could experience loss of sensation at the tissue donor site and some weakness in your abdominal muscles.

Preparing for surgery

It is important to mention all medication you use to your surgeon. The use of specific medication (like aspirin, ascal, APC, plavix, etc.) should be stopped for several days prior to surgery. If you smoke, you will need to stop at least 3 months prior to your surgery. Nicotine use increases the risk of complications after surgery such as infection or delayed wound healing. No smoking is an unconditional requirement.

You will receive recommendations where to buy an abdominal binder. One of our physician assistants will provide a special supportive bra and all its specific information. You will also receive therapeutic stockings after surgery.

Following the appointment with your plastic surgeon, an appointment for a CT scan will be set up. This CT scan will show the blood vessels of the abdomen and chest in preparation for surgery. During the second appointment, your plastic surgeon will show you the CT scan images and assess if the blood vessels are suitable for this type of surgery. This scan is not meant to detect any other abnormalities. In order to make this scan your kidneys have to function properly. Therefore, if necessary, you will undergo blood tests to evaluate this in advance.

The days prior to your breast reconstructive surgery, you will have another appointment in our plastic surgery outpatient clinic. Using the images obtained from the CT scan a map will be drawn on your abdomen with waterproof ink (you can shower after this has been done). This helps us mapping the position of the blood vessels and where we will make the incisions. During this appointment, you can ask any last-minute questions.

On the day of the surgery, you are expected at the hospital at 7:00 in the morning. Information regarding the admission will be given to you by e-mail and/or per phone. We will also arrange an appointment to see one of our anaesthetists about 2 weeks prior to your operation.

After surgery

During your surgery, 2 drains will be placed near the abdominal wound site as well as 1 in your new breast. These drains will be removed after several days depending on fluid outputs. Generally, you will stay in the hospital around 4-5 days.

The first 24 hours after surgery will be spent in our Intensive Care Unit, where we will monitor the flap/breast tissue’s blood flow at least every hour. The next 24 hours this will be done every 2 hours and the day after every 4 hours, etc. One of our plastic surgeons will check on you every day.

As soon as you are able to eat, drink, mobilize and your pain is well controlled, you can go home to recover from there. This might be with or without drains. At the time of discharge, you will receive additional information and recommendations for recovery at home as well as a brochure with guidelines.

Complications

Like any invasive surgical procedure, the DIEP flap procedure has risks such as bleeding, infection or tissue necrosis. The risk of these complications is higher with smoking and diabetes. A lack of blood flow to the newly placed tissue is a rare, but a potentially severe complication. This might lead to complete flap failure. Other rare complications are pneumonia, thrombosis or lung embolism.

Costs

In most cases your insurance company will cover the costs for this surgery.

When should you contact the hospital?

Should you experience an infection (redness of the wounds, fever, increased pain or swelling), please call our department between 8.00 am and 16.30 pm. The number is (+31)088 979 44 99.

At night and during the weekends our plastic surgeon on-call can be reached via the Emergency Department (SEH) in the HMC location Westeinde. Phone number (+31)088 979 23 80.

In conclusion

Should you have any questions after reading this webpage, please do not hesitate to contact us on (+31)088 979 44 99. We are available from Monday to Friday from 8.00 am to 16.30 pm.