DIEP Flap Breast Reconstruction
Female Overview

At the botonics International Breast Unit, we specialise in microsurgical breast reconstruction using the gold standard DIEP flap technique.

This can be performed to reconstruct one or both breasts using natural tissue from the patient’s own body at our world class facilities in Harley Street, London, England.

The DIEP breast reconstruction technique represents the state of the art breast reconstruction requiring much longer time in theatre and greater surgical skill and experience relative to other reconstruction techniques. DIEP stands for deep inferior epigastric perforators, and involves the harvesting of skin, fat and blood vessels from the abdomen.

Advantages of the DIEP Flap Technique

• no sacrifice of abdominal muscles is necessary (i.e. as is the case with TRAM flap)
• abdominal skin is removed at the same time, similar to an abdominoplasty resulting in an improved contour and flatter stomach.
• faster recovery and lower risk of abdominal wall hernias relative to the TRAM technique
• because the breast is rebuilt with natural body fat the breast will feel, move, gain weight and lose weight just like a natural breast
• no chance of rupture or capsular contracture as in the case with implant surgery

Disadvantages of the DIEP Flap Technique

• the procedure takes about twice as long to perform as compared to the TRAM technique
• abdominal skin must be available to harvest (which may be an issue if the client does not have excess abdominal skin, or has had an abdominoplasty or DIEP flap procedure previously)
• potential denervation and temporary weakening of the abdominal musculature
• few breast reconstruction centres offer the option due to the complexity of the surgery
• blood flow to the DIEP flap may not be as good as that of the muscle-sparing TRAM operation

How DIEP Flap Breast Reconstruction is Performed

New breast tissue is created from skin, fatty tissue and tiny blood vessels (deep inferior epigastric perforators), collectively known as a ‘flap’. These perforators (blood vessels) are then matched and reattached at the mastectomy site, using a microscope. No abdominal muscle is used in this process, which makes it a more superior and refined technique over the TRAM flap procedure. Both the DIEP flap and the TRAM flap, however, require a small incision into the abdominal (rectus) muscle, in order to access the blood vessels required to keep the tissue alive.

Because the DIEP flap procedure can restore both the surface area and volume of a breast, this makes it ideal for both immediate and delayed breast reconstruction. Immediate reconstruction is where mastectomy and reconstruction are carried out together versus delayed reconstruction, when reconstruction is done later. This is decided based on several factors – personal preference and medical status or contraindications for immediate reconstruction, such as a congenital chest wall deformity (Poland’s syndrome). Chemotherapy is also contraindicated, and it’s important to note that smoking and alcohol affect the healing process. See here for more information on pre care and after care

Restoration of the nipple is performed a few months’ later. The new areola is created with a disk of skin from the abdomen, at the same time as the new breast(s) and the nipple, at a later date. with a flap of skin moulded into shape. This of course is all up to the patient and some are happy without a new nipple. Tattooing is used to create the darker colour of the areola and nipple.

There will be a little scarring around the areola of the new breasts, but this can be hidden by the tattooing, and will fade substantially over time. On the abdomen the scar will be linear across the bikini line, just like the scar from abdominoplasty.

The reconstructed breasts may even be firmer and more youthful in appearance than natural breasts. The patient will benefit from a breast lift, due to the removal of excess skin, and often the nipple is reattached/placed higher up on the breast. Also, there is often ample tissue from the abdomen so the surgeon can potentially given an increase in breast size for women who initially had smaller breasts.

It is important to note that DIEP Flap can be performed once only, hence some patients may choose to have a prophylactic mastectomy on the non-cancerous breast in order to reduce the chance of developing cancer later on.
There will be a loss of sensitivity/sensation in the new breasts, nipples and a part of the abdomen around the scar.

Other Options

• Similar to a DIEP flap is the muscle-sparing free TRAM flap, where a small amount of muscle is used to rebuild the breast
• Implant reconstruction

botonics for Breast Reconstruction

We’re breast reconstruction specialists, having been leaders in the plastic surgery market since 2005.