The DIEP flap is the most advanced form of breast reconstruction available today.

The procedure uses the patient's own abdominal skin and fat to reconstruct a natural, warm, soft breast after mastectomy. Unlike the TRAM flap, the DIEP preserves all the abdominal muscles. Only abdominal skin and fat are removed similar to a "tummy tuck". Saving the abdominal muscles (and the main motor nerves that power the muscle) means patients experience less pain, enjoy a faster recovery, maintain their core strength long-term, and have a lower risk of abdominal complications.

The skin and fat below the belly button feels very similar to breast tissue. It is the perfect choice to replace the breast tissue removed by the mastectomy.

The blood vessels ("perforators") that keep the lower abdominal skin and fat alive travel just beneath or within the abdominal muscle. A small incision is made in the abdominal muscle to access these vessels. A muscle without a healthy nerve supply will lose it's tone, strength and function. Great care must therefore be taken to identify and preserve the main nerves supplying the abdominal muscle to decrease the risk of abdominal complications, especially a bulge or hernia.

The prepared tissue ("flap") is then disconnected from the body and transplanted to the chest using microsurgery. The surgeons then shape the tissue to create the new breast.

Women also enjoy the added benefit of a flatter abdomen with results that ideally mimic a “tummy tuck”. The risk of abdominal complications such as bulging and hernia is also very small, much smaller than with the TRAM flap.

Most patients are also candidates for sensory nerve reconstruction. This new procedure reconstructs nerves that supply feeling to the breast that are cut by the mastectomy. While it typically won't reproduce the sensation provided by Mother Nature, sensory nerve reconstruction leads to improved return of feeling to the reconstructed breast. Unfortunately few centers include this additional step routinely so be sure to ask your surgeon specifically about this.

Sometimes all the lower abdominal tissue is needed to reconstruct one breast. Occasionally this cannot be performed as a single flap. For example, the patient may have a midline abdominal scar from previous surgery or may be quite thin. In these cases, the lower abdominal tissue can be transplanted as 2 separate flaps which are then reconnected on the chest using microsurgery to create one breast. This technique is known as the stacked DIEP flap procedure.

Sometimes the patient’s anatomy isn’t ideal for a DIEP flap because a large amount of muscle separates the blood vessels that are needed for the best blood supply. In this situation, an APEX flap modification should be strongly considered.  

Patients who have arm lymphedema as a result of previous breast cancer surgery may also be candidates for vascularized lymph node transfer in combination with DIEP flap reconstruction, as long as they are already maximizing their lymphedema therapy (special type of physical therapy).

Ideally, a team of two microsurgeons should perform complex microsurgical procedures like the DIEP flap. This ensures the patient benefits from the expertise of two specially trained surgeons and also significantly decreases the length of the surgery and anesthesia time, which in turn decreases the risk of complications.

Patients are strongly encouraged to consider teams that specialize in these surgeries as this can make a significant difference in the results. High volume centers tend to have the greatest expertise and provide the best outcomes and highest success rates (over 99%).

A second procedure — referred to as the "revision stage" or "stage 2" — is often performed a few months after the initial reconstruction to fine-tune the reconstructed breast(s) in order to achieve the best overall cosmetic results.. 

Content provided by PRMA Plastic Surgery | Center for Advanced Breast Reconstruction