After a mastectomy, which involves the surgical removal of one or both breasts during breast cancer treatment, you may find breast reconstruction surgery to be an important consideration.

Among the various reconstruction options available, one technique to consider is deep inferior epigastric perforator (DIEP) flap breast reconstruction, which allows the surgeon to use your own tissue to create new breast mounds.

DIEP flap breast reconstruction makes up about 10 percent of all breast reconstructive surgeries. This article explores the DIEP flap technique, as well as its benefits, considerations, and which individuals it might suit.

DIEP Flap Breast Reconstruction Procedure

The DIEP flap breast reconstruction procedure is performed after a mastectomy. It can either be done at the same time as the mastectomy or in the days or months afterward.

A plastic surgeon who specializes in microsurgery will perform the procedure. Microsurgery involves microscopes and specialized instruments to connect and repair blood vessels.

The procedure itself involves surgically removing fat, skin, and small blood vessels from the abdomen that are then reattached to the chest. The general steps of the procedure include the following:

• Anesthesia — The care team will use general anesthesia, which involves administering a combination of medications to keep you asleep during surgery. This means that you will be unconscious for the entire procedure.
• Tissue dissection — Your surgeon will make a surgical cut at your bikini line to open up your lower abdomen. They will cut out the flap of tissue that will later be connected to your chest.
• Microsurgery — Using a microscope, your surgeon will cut the blood vessels from the abdomen and connect them to blood vessels in the chest. This procedure will be done quickly and carefully to ensure there is a constant flow of blood and oxygen to the flap tissue.
• Breast shaping — The tissue from the flap is put in the breast area and shaped like a breast.
• Drainage and closure — Your surgeon may place drains in the abdomen or chest area to allow fluids to drain after surgery. The wounds on the abdomen and breasts will then be stitched shut.

What Makes a Good DIEP Flap Candidate?

Certain characteristics may make you a good candidate for a DIEP flap reconstruction. These attributes include having extra abdominal fat and no history of certain abdominal surgeries. Also, certain blood vessel factors in the abdomen can determine if someone is a good fit for a DIEP flap.

Excess Abdominal Fat

Because this procedure takes fat from the abdomen and uses it to form your new breasts, you must have enough abdominal fat to use. For very thin individuals or those with a low body fat percentage, there will likely not be enough fat to remove.

No History of Certain Abdominal Surgeries

Having specific abdominal surgeries before a DIEP flap will put you at greater risk of complications. One such surgery is a tummy tuck, also known as abdominoplasty. This is a cosmetic procedure done to reduce the size and appearance of the stomach.

In addition, if you’ve had a colostomy, you may not be a DIEP candidate. This surgery connects the large intestine to an opening in the abdomen and is usually performed after a bowel obstruction surgery or injury. Usually, individuals who have had C-sections and hysterectomies can still be candidates for a DIEP flap.

Additionally, the presence and location of certain blood vessels in the abdomen can make someone a good or bad candidate for a DIEP flap because this procedure involves using tissue from the lower abdomen. A proper blood supply ensures successful tissue transfer and healing. Without adequate blood flow, the tissue may not survive, making the candidate less suitable for this type of reconstruction.

Benefits of DIEP Flap Surgery

There are several benefits to the DIEP flap breast reconstruction procedure compared to other reconstruction surgeries. These include:

• A more natural look — DIEP flap breast reconstruction surgery often gives a more natural appearance compared to implants. Because the tissue is from your own body, the tissue may settle similarly to natural breasts.
• Relatively easy recovery — Compared to other reconstructive surgeries, such as a transverse rectus abdominis musculocutaneous (TRAM) flap procedure, recovery from DIEP flap surgery is shorter. Because the TRAM flap procedure takes muscle out of the abdomen rather than just the surrounding fat, it tends to have a longer recovery time.
• More sensation — Because the DIEP flap uses your own tissue and reconnects blood flow to that tissue, there can be more sensation in the new tissue in the breasts.
• Ease of lifestyle changes — With breast implants, you need to be careful about weight gain and loss, whereas after DIEP flap procedures, your body can handle weight fluctuations.

Risks

Like any surgery, there are a few risks associated with DIEP flap breast reconstruction, such as tissue death, hernia, and fluid buildup.

Necrosis

Necrosis, or tissue death, is a possibility when tissue or fat is being taken from one part of the body to another. Sometimes, the new tissue is rejected by the surrounding tissue, and it starts to break down and die. In this case, the tissue may start to turn blue or black and may be colder than the rest of the surrounding tissue.

Necrotic tissue can be removed by surgery under general anesthesia. Depending on how severe the necrosis is, this procedure will involve removing a part of the breast or the whole breast.

Necrosis can also happen specifically in fat cells, leading to lumps and bumps in the breast tissue. While necrosis of fat may sometimes be removed by the body, it also may not. These lumps usually show up at around eight to nine months after surgery. They may seem scary because finding a lump in the breast is a typical sign of breast cancer, but lumps from fat necrosis can be removed surgically.

Hernia

Swelling or bulging of an intestine from the surrounding connective tissue is known as a hernia. While rare, hernias in the abdomen may happen if there is abdominal muscle strain after the DIEP flap procedure.

Fluid Buildup

Sometimes, abdominal swelling in the lower abdominal area after surgery can create a bulge that reminds some MyBCTeam members of a Ken doll. If this happens, it is best to consult with a doctor immediately. The swelling could be caused by lymphedema, which is a buildup of lymphatic fluid in the area.

Recovery

After surgery, you will likely be in the hospital for up to five days. In the first few days after discharge from the hospital, you will have to clean the incision sites and empty the drains.

Recovery from a DIEP flap can take six to eight weeks and may require future surgeries for you to be happy with the shape of your new breasts. There can be soreness and swelling around the breasts and abdomen for a few weeks after surgery. Numbness of the breasts and abdomen can last up to a year.

Some people also report feelings of tightness. One MyBCTeam member said, “Your tummy is very tight after surgery, so sleeping flat is impossible. I even tucked a few pillows under my knees to be comfy.” This tightness usually resolves after recovery.

“Now that I am six months out from my reconstruction, I am feeling great!” another member said. “My abdominal area is still a little tender, but I am completely back to all my activities.”

Studies that have looked into the overall satisfaction rate have found that more than 90 percent of people studied who received DIEP flap reconstruction were satisfied with the procedure.

Consult With Your Doctor

If you are interested in exploring DIEP flap breast reconstructive surgery as a possible option, consult with your doctor. They will know if you are a good candidate and will be able to recommend a qualified plastic surgeon. If you have any side effects after the DIEP flap, call your care team right away.

Find Your Team

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 64,000 members diagnosed with breast cancer come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Are you living with breast cancer? Are you trying to decide which reconstructive surgery to pursue? Share your experience in the comments below, or start a conversation by posting on your Activities page.