Breast Reconstructions using the Abdominal tissue – DIEP Flaps
The most common autologous tissue, using your own tissue, breast reconstruction is the use of abdominal tissue also known as the DIEP flap ( Deep Inferior Epigastric Perferator flap). The DIEP flap requires the use microsurgical technique to transfer skin and fat from the abdomen to create a new breast. This skin patch’s blood supply is provided by a network of small blood vessels that travels within your rectus abdominus muscle (the 6 pack muscles). These networks of blood vessels could be teased out and separated from the rectus muscle allowing preservation of this important abdominal muscle. Dr. Goldberg harvested this abdominal skin patch and transfer it to your mastectomy site and connected to the recipient vessels within your chest. The skin and fat is then molded to form a new breast.
The DIEP uses the latest advance in microsurgery in creating a breast while preserving the important muscles of your abdomen. Preservation of the rectus muscle is important because it maintains the integrity of your abdominal strength and thus allowing you to return to your daily activities much faster. Since the DIEP flap is made of your natural skin and fatty tissue, it offers the most natural appearing breast reconstruction without the use of an implant. Patients with DIEP flap reconstructions require fewer overall number of surgeries and office visits when compare with patients who have implant base reconstructions.
What is the recovery process?
The DIEP flap surgery could take anywhere from 4 to 6 hours per side depending on the anatomy and size of the reconstruction. You will be closely monitored in the hospital for 4 to 5 days post-operatively. You will go home with some tube drains, one in your breast, and two in the abdomen. You will be off work for 3 to 4 weeks depending on the type of work you do. A young patient who perform desk work may return to work as soon as 3 weeks. For the donor site on t your abdomen, you will have a scar that is similar to a tummy tuck scar which could be hidden within your undergarment as seen in the feature case below.
Who is a candidate for DIEP flap reconstruction?
Patients who have excess abdominal tissue is a candidate for breast reconstruction using DIEP flap. The ideal candidate is a patient who has BMI (Body Mass Index) of less than 30 kg/m2. Patients with BMI >35 kg/m2 has a higher complication rates such as fat necrosis (hardening of the fat), seroma (fluid collection), and wound healing problems in the abdominal donor site.
You could have DIEP flap reconstruction as an immediate versus a delayed breast reconstruction. Patients who requires radiation to the chest wall after mastectomy, would especially benefit from the DIEP flap reconstruction. The flap will replace radiation damage skin and bring healthy fat tissue and promote healing of the chest after radiation.
Length of surgery: 5-10 hours per breast
Anesthesia: General anesthesia
Length of stay: 5 to 6 days in-patient stay
Recovery time: 6 weeks of absolute no heavy lifting (anything >5lb). 8 weeks prior to return to light duty.