After a mastectomy, you may decide to have breast reconstruction surgery. In some cases, you can use your own tissue instead of implants to rebuild your breast. That’s called flap surgery.
What Is DIEP Flap Reconstruction Surgery?
DIEP is one type of flap surgery. It stands for deep inferior epigastric perforator and is named for an artery that runs through your abdomen, or lower belly.
DIEP flap “involves using tissue from the lower abdomen and utilizing microsurgery, surgically connecting small blood vessels to establish a blood supply for the tissue that is moved from the abdomen to the chest, to create a new breast,” explains Neelesh Kantak, MD, Chief of Plastic Surgery for Mid-Atlantic Permanente Medical Group.
Your surgeon will take skin, fat, and blood vessels, but no muscles, from your lower belly above your pubic bone. This is sometimes called the “tummy tuck” area.
Using your own tissue often creates more natural results. And you can avoid the complications that can come with breast implants.
When Do You Get It?
If you have DIEP right after your mastectomy or lumpectomy (partial breast removal), you won’t need two separate operations. Some people feel like this lets them return to their normal life sooner.
But if you’ve already had a mastectomy and decide on breast reconstruction later, DIEP can still be an option.
If you’re thinking about a breast reconstruction with DIEP flap, your doctor can help you decide the best timing.
Who shouldn’t get DIEP flap surgery?
This type of surgery isn’t right for everyone. You may not be able to get DIEP if:
You don’t have enough belly tissue. For instance, you’re very thin or you’ve had liposuction.
You’ve already had flap surgery. If tissue from your belly has already been used to reconstruct your other breast, there may not be enough left to use.
You’ve had some types of abdominal surgery. You might still be able to have a DIEP flap after a C-section or hysterectomy. But other types of surgeries, such as a colostomy, which changes where poop comes out of your body, may prevent this procedure from being done.
There’s an issue with the blood vessels in your belly. For example, they could be too small to transfer well. Or sometimes, the vessels that your surgeon needs to use aren’t in a location suitable for use during surgery.
How common is DIEP flap surgery?
DIEP is a newer procedure. It was first done in the 1990s. Since then, more and more surgeons have become trained to do it. According to the American Society of Plastic Surgeons, over 23,000 DIEP flaps were performed in the U.S. in 2020.
But it’s still not an option at every hospital. You’re more likely to find a surgeon trained in DIEP if you live in a large city.
Saline breast implants are still the most popular way to reconstruct a breast.
What to Expect With DIEP Surgery
Before your surgery date, your surgeon will likely ask you to:
- Have lab work done. A blood test can confirm if you’re healthy enough to have the procedure.
- Quit all forms of tobacco. It can cause problems with the anesthesia, put extra strain on your heart during the surgery, and slow down your healing.
- Stop certain medications. Make sure your doctor knows all drugs and supplements that you take, even if they’re over-the-counter products.
Once you arrive at the medical center for your surgery, you’ll be given anesthesia through a vein in your arm (IV). That way, you’ll sleep through your procedure. You shouldn’t feel any pain during it or be aware of what’s going on.
During DIEP surgery, your doctor will make a cut along your bikini line from hip to hip. They’ll carefully remove a flap of skin, fat, and blood vessels from your lower belly.
They’ll then make a cut in your breast, usually following the same incision line from your previous surgery. The flap of tissue from your belly will be moved here and formed into the shape of a breast.
Using a microscope, your surgeon will connect the blood vessels of the transferred tissue to those in your chest. This allows your new breast tissue to grow and thrive.
Very small drains will be placed near the cuts in your breast and belly. These will stay in for a few weeks to remove extra fluid from the area, help reduce swelling, and speed up healing.
Lastly, stitches or staples will be used to close the cuts.
DIEP flap is not a quick outpatient surgery. “[It’s] a complex procedure that involves long operative times — approximately six to eight hours to reconstruct one breast, and approximately 10-14 hours to reconstruct two breasts,” says Kantak.
Afterward, your body will need plenty of time to heal.
“Patients typically stay in the hospital for two to three nights postoperatively, and the recovery period is generally around six weeks,” says Kantak.
You’ll have several cuts to take care of. Your doctor will also give you lots of guidelines to follow while you heal. For instance, you’ll need to avoid high-impact exercise or heavy lifting for a while.
Risks and Complications of DIEP Flap Surgery
Like all surgeries, there are some risks to DIEP.
For instance, “there is a small risk of the DIEP flap tissue not surviving if the blood supply is interrupted or is inadequate,” says Kantak.
It’s rare, but sometimes the tissue moved to your chest doesn’t get enough blood flow and dies. If it’s a small area, your surgeon can trim away the dead tissue. If it’s most of the tissue, they’ll have to replace the whole flap.
Or the blood supply could get cut off in spots, causing scar tissue. These areas might feel like lumps in your breast. They may or may not go away on their own.
There’s also a chance you could get a hernia or muscle weakness around the spot in your lower belly when the surgeon removed the tissue. You usually need surgery to fix a hernia.
Call your surgeon after surgery if you have:
- Bleeding
- Signs of infection around an incision (such as pus)
- Intense pain
- Trouble breathing
- Fever
DIEP Flap Surgery Recovery
You’ll probably need to wear a special compression bra for a few weeks. This is like a snug-fitting sports bra. It can help keep you comfortable and support the healing process.
You may also be given a compression wrap to wear around your belly.
After DIEP surgery, it’s common to have:
- Bruising
- Soreness
- Pain
- Swelling
- A feeling of tightness around your cuts
- Numbness in your belly or breast
While most of these will go away after a few weeks, numbness can last up to a year. Still, talk to your doctor if you have any symptoms that concern you.
After DIEP flap surgery, you’ll have a scar across your lower belly, under your bikini line. This often fades in about 12-18 months. You’ll also have a scar on your breast. What it looks like often depends on the type of mastectomy or lumpectomy you had before your flap surgery.
If you choose to have nipple reconstruction surgery, that’s usually done once you’ve fully healed from your DIEP.
Takeaways
One way to reconstruct your breast after a mastectomy is DIEP flap surgery. A specially trained surgeon uses tissue from your lower belly to remake your breast. The success rate for this procedure is between 96% and 99%, and the results are often very natural-looking. Still, its recovery time is often longer than that of a breast implant. Talk to your surgeon about the pros and cons of DIEP flap surgery and whether you’re a good candidate.
DIEP Flap Surgery FAQs
What is the difference between a DIEP flap and a tummy tuck?
A DIEP flap surgery transfers tissue from your lower belly to your breast. A tummy tuck, or what’s called an abdominoplasty, removes extra fat and skin from your stomach area while also tightening the muscles there.
You might choose to get a tummy tuck because of how your body has changed, for instance, after pregnancy or once you’ve lost an extreme amount of weight.
How painful is DIEP flap surgery?
It’s not just your chest that will be sore after your procedure. Your belly will probably be very tender, too. This is common after any kind of abdominal surgery. You might find it painful to change positions, such as going from standing to sitting or vice versa. But you should be able to manage the pain, and it should lessen over time. If not, talk to your doctor.
What to eat after DIEP flap surgery
Eating healthy foods can help boost your immune system and promote healing. At meals, try to fill your plate with:
- Fruits and vegetables. They’ll help your body fight off the fatigue that’s common after surgery.
- Whole grains. Options such as quinoa and oatmeal are high in zinc, which helps your immune system function properly.
- Lean proteins. Choose beans, nuts, seeds, fish, eggs, chicken, and low-fat dairy. They can help with cell repair.
- Healthy fats. Try to cut back on saturated fats (for instance, butter and full-fat dairy) and trans fats, which are in fried or processed foods. Monounsaturated and omega-3 fats are better choices. They help decrease inflammation inside your body. You can find them in olive oil, nuts, and avocado.
