DIEP flap reconstruction is a form of Autologous breast reconstruction, meaning it uses your own tissues rather than an implant to create a breast mound. It can be used to carry out either immediate (at the time of mastectomy) or delayed (after breast cancer treatment is finished) breast reconstruction.
DIEP stands for Deep Inferior Epigastric Artery Perforator flap, which is the name of the blood vessel that is used to keep the flap alive. A DIEP flap is a ‘free’ flap which means the blood vessel is disconnected and then reconnected to a blood vessel in your chest area (either near your breast bone or in your armpit). Carrying out free-flap reconstruction surgery is complex and lengthy and this is only done by Plastic surgeons. For our patients free flap surgery is carried out at the Royal Free Hospital by Mr Sojitra. This form of surgery is only carried out in people who are not smokers (or using nicotine products) and in people who are not very overweight (BMI of less than 32). If you are smoking or need to lose weight you may be advised to either have a DIEP done as a delayed reconstruction or have a different form of reconstruction. Other people who may not be suitable for this surgery are those who have had certain types of abdominal operations in the past leaving them with scars running up and down the middle of their tummy.
The tissue that is used in a DIEP reconstruction is the tummy fat; because breasts are made of fatty tissue this gives the most natural of breast reconstructions. Because the tummy fat is removed, this surgery also results in a ‘tummy tuck’ procedure. There will be a long scar after this operation going from one hip bone across to the other. The blood vessel that is used is carefully removed from the tummy wall muscle that it runs in, meaning that no muscle is removed and the abdominal wall is not weakened.
Before this type of surgery you will need to have a detailed scan showing the blood vessels in your tummy area. Even if the results of this are satisfactory at the time of surgery the blood supply may not be good enough. This is not very common, but in that case the Plastic surgeon may need to convert your flap to a pedicled TRAM flap instead. A pedicled TRAM flap keeps its own blood supply with it, so is less likely to fail. This will require some of your abdominal wall muscles to be moved also with the flap, which can result in some weakness of the abdominal wall after surgery.
After this form of surgery about 1 in 10 women will need to return to surgery because of problems with the blood supply, and in 3-5% of women the flap will not survive. More commonly areas of ‘fat necrosis’ may occur in parts of the flap where the blood supply has not been that good. These areas can feel firmer and may require assessment in the breast clinic to make sure they are just fat necrosis. Fat necrosis can improve over time, but if it doesn’t further surgery may be required to remove it if it is troublesome.