Breast reconstruction using a DIEP flap

What is it?

The DIEP flap (Deep Inferior Epigastric artery Perforator flap) uses skin and fat from the abdomen between the navel and the pubic area to construct a new breast. The abdominal muscles remain intact, which means less weakening of the abdominal wall. This technique is currently regarded as the golden standard for breast reconstruction

Course of the procedure

The DIEP flap is a free flap. That means that microsurgical techniques are employed, which means that the procedure takes longer (7-8 hours on average). Together with the skin flap from the abdomen, a vascular pedicle in the rectus abdominis muscle is revealed. Then, the veins are cut and the flap is transplanted onto the chest. The veins are then connected to the veins behind the breastbone using a microscope, so that the transplanted flap continues to receive blood supply and can survive.

The skin flap is then modelled into a breast. The wound in the abdomen is closed as in a classic abdominoplasty (abdomen correction). This means that there will be a scar in the lower abdomen that can be hidden beneath underwear. This technique has many advantages. Blood supply to this flap is better than for the TRAM flap. The flap is mouldable enough to be able to sculpt a beautiful breast.

Results

The long-term results are excellent because this breast evolves in a natural manner as you age. This contrasts with breast implants which often look increasingly unnatural over the long term, increasing the asymmetry with the other breast and often requiring additional procedures at a later date. The disadvantage of the DIEP flap is the relatively higher (one-off) price and the risk of clot formation in the vascular anastomosis area. If that occurs, prompt intervention is necessary to dilate the blood vessels and save the reconstructed breast.

A DIEP flap can be regarded as a one-off, more taxing procedure which also requires a relatively long period of recovery, but whose results are worth the investment in the long term.

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