DIEP (pronounced deep) flap surgery is a common type of breast reconstruction that uses tissue (fat) and a blood supply from the lower abdomen to form a new breast mound(s) following a mastectomy. It is named for one of the blood vessels utilized during the tissue transfer, the Deep Inferior Epigastric Perforator artery.
Around the early 2000s, with advancements made in microsurgical technology and technique, the DIEP surgery became a more widely adopted choice for breast reconstruction. Today, DIEP is considered one of the preferred options for breast reconstruction due to its natural appearance and low maintenance upkeep.
Since the reconstructed breast mound (DIEP flap) is made from natural tissue (abdominal fat), it ages naturally with the body, doesn’t involve the risks associated with implants, and rarely requires future surgeries once the initial reconstruction is complete.
Unlike older similar techniques of reconstruction, like the TRAM (transverse rectus abdominis myocutaneous) flap, DIEP surgery avoids significant involvement of the abdominal muscles, reducing the risk of complications at the donor site (lower abdomen) such as weakness or development of hernias.
During the lengthy (~6-10 hours) DIEP procedure:
- Skin, fat, and blood vessels from the abdomen are carefully removed. The blood vessels (one vein and one artery) are fully disconnected for transfer.
- The blood vessels are then reconnected to vessels (one existing vein and one existing artery) in the chest, allowing the transferred tissue (abdominal fat) to survive and thrive to form a new breast mound.
- The abdominal muscle is left largely intact, offering a faster recovery and less chance of abdominal wall weakness or hernia development down the road.
A popular “silver lining” to this reconstruction technique is that it is essentially the same procedure as a tummy tuck, only the excess abdominal tissue is used to create the reconstructed breast mound instead of being discarded after removal. However, the scarring associated with this surgery is significant and notable.
- Abdominal Scar: This will be a horizontal scar running from hip to hip, above the pubic area. Similar to a tummy tuck incision, but generally a few inches higher.
- Breast Scar: The scars on the breast will vary depending on the reconstruction technique, but it often follows the contours of a football shape.
These scars are typically well-concealed under clothing and fade over time with proper care.
Ideal candidates are generally those looking for a natural, long-lasting breast reconstruction using their own tissue, while being in good general health and having enough abdominal fat to support a full reconstructed breast mound- or two!
While previous surgeries like a C-section may not be disqualifying, extensive abdominal surgeries (such as previous tummy tucks or major abdominal reconstructions) might reduce the feasibility of DIEP surgery due to scar tissue buildup or compromised blood vessels.