DIEP Flap Surgery

What is DIEP flap surgery?

DIEP flap surgery is a type of breast reconstruction. DIEP (deep inferior epigastric perforator artery) is a blood vessel in your belly. A surgeon uses blood vessels, fat and skin from your lower belly to rebuild your breast during the procedure.

One of the major benefits of DIEP flap surgery is that the surgeon doesn’t remove any muscle from your abdomen. Some other procedures, such as TRAM (transverse rectus abdominal muscle) flap surgery, take muscle from your belly or other areas of your body, making the recovery process longer.

Who needs DIEP flap surgery?

DIEP flap surgery is a way to reconstruct your breast after breast cancer surgery. You may choose to have breast reconstruction after a mastectomy (breast removal) or lumpectomy (partial breast removal). DIEP flap surgery might happen at the same time as your breast cancer surgery (immediate reconstruction) or after (delayed reconstruction).

Breast reconstruction is a personal choice. Some people choose breast reconstruction to:

• Give a more balanced look to their chests.
• Help clothes fit better.
• Improve their self-esteem.

Is DIEP flap surgery the only type of breast reconstruction?

There are several ways to reconstruct a breast. If you decide to have breast reconstruction, you should discuss the risks and benefits of each option with your healthcare provider. The two main types of reconstruction are:

• Flap reconstruction: Uses tissue from different areas of your body to reconstruct your breast.
• Implant reconstruction: Uses a saline or silicone implant to rebuild your breast.

Who shouldn't have a DIEP flap surgery?

Not everyone will be a candidate for DIEP flap reconstruction surgery. You might not be able to have this procedure if you:

• Already had DIEP flap or TRAM surgery to reconstruct your other breast. Blood vessels, fat and skin can only be taken from your belly once.
• Don’t have enough extra fat and tissue in your abdomen. This might be the case if you’re very thin or previously had abdominoplasty (tummy tuck) or liposuction. In these cases, a stacked DIEP surgery (taking tissue from both sides of your belly instead of the middle) might be an option.
• Have abnormal blood vessels in your belly. Sometimes, blood vessels are too small or aren’t in the right location for DIEP flap surgery. But surgeons are developing new techniques so they can still perform the procedure by rearranging blood vessels.
• Previously had other types of abdominal surgery. Abdominal wall reconstruction or a colostomy might prevent you from having DIEP surgery. But most people can still have DIEP surgery after procedures such as a C-section, open hysterectomy or tubal ligation.

What kind of surgeon performs DIEP flap surgery?

A plastic surgeon with specialized training in microvascular tissue transfer performs DIEP flap surgery. Microvascular tissue transfer is a complex technique to transfer blood vessels from one part of your body and reattach them in another part of your body.

How common is DIEP flap surgery?

In 2017, DEIP flap surgery accounted for about 10% of all breast reconstructions. Saline implants are the most popular form of breast reconstruction. But as more surgeons receive training in the complex DIEP technique, the procedure will likely become more common.

What happens before DIEP flap surgery?

Your healthcare provider will give you specific instructions about how to prepare for DIEP flap surgery. You may need a physical exam and lab tests to make sure you’re healthy enough for surgery. Your provider might take photos of your breasts and abdomen and order imaging scans to plan your surgery.

You should also:

• Do light exercise in the weeks and months before surgery to improve muscle strength and increase cardiovascular health.
• Quit smoking and avoid all products containing nicotine.
• Stop taking certain medications such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

What happens during DIEP flap surgery?

DIEP flap surgery typically takes anywhere from six to eight hours. The procedure varies depending on whether you’re having immediate or delayed reconstruction. Some people having delayed reconstruction may have had a tissue expander placed under the skin of their chest during their mastectomy. If you had a tissue expander, it will be removed during your flap surgery.

In general, here’s what you can expect:

• Anesthesia: You receive anesthesia through a vein in your arm. Anesthesia helps you go to sleep during the procedure so you don’t feel any pain.
• Incision: Your surgeon makes a long incision (cut) in your lower belly. The incision is from hip bone to hip bone, between your belly button and the start of your pubic hair.
• Tissue removal: A single flap of skin containing fat and blood vessels is removed from your abdomen. Your surgeon doesn’t remove any muscle.
• Tissue transfer: Your surgeon makes an incision in your chest (usually the same incision line from your mastectomy or lumpectomy). They transfer the flap to the breast site and carefully attach blood vessels from the flap to blood vessels in your chest.
• Breast shaping: Once the blood vessels are attached, your surgeon shapes the tissue to resemble the natural shape of a breast.
• Drain placement: Your surgeon will probably place drains in the incisions on your belly and chest. Drains help remove fluid, reduce swelling and aid the recovery process. They’ll be removed a few weeks after surgery.
• Closure: Your surgeon closes the incision in your chest and abdomen with stitches or staples. They position the skin of your belly so your navel is still in a natural position.

What happens after DIEP flap surgery?

After DIEP flap surgery, you stay in the hospital for two to five days. Your healthcare provider will give you detailed instructions about:

• How to care for your incision at home, including emptying drains.
• Medicines to take and avoid.
• What kind of garments to wear.
• When to return to normal activities.

What are the benefits of DIEP flap surgery?

Benefits of DIEP flap surgery include:

• More natural look: Many people feel that using their own tissue gives their new breast a more natural shape and feel than implants.
• Muscle-sparing procedure: Your surgeon doesn’t cut or remove muscle from your belly, so you keep abdominal strength. Recovery time is also shorter than that of other flap procedures.
• Permanent results: DIEP flap surgery offers permanent results. Implants may rupture, harden, shift or need to be adjusted if you gain or lose weight.
• Preserved breast sensation: You may be able to keep some sensation in your reconstructed breast. Ask your surgeon about the possibility of transferring sensory nerves from the flap to your chest.

What are the risks of DIEP flap surgery?

Complications from DIEP flap surgery aren’t common, but they can include:

• Hernia: Sometimes, part of an intestine can bulge through a weak spot in your belly muscles after this surgery.
• Lumps: Firm scar tissue may form in the reconstructed breast and feel like a lump. The lump may go away on its own or your surgeon can remove it.
• Necrosis: Some tissue may die if the transferred flap doesn’t get enough blood. The skin can turn black and feel cold to the touch. Your surgeon needs to remove the dead tissue. Rarely, the entire flap develops necrosis and needs to be removed.

What is recovery like after DIEP flap surgery?

Recovery after DIEP flap surgery can take six to eight weeks. Your surgeon may ask you to wear a compression garment around your chest or abdomen for several weeks. You’ll need to avoid strenuous activities, heavy lifting or overhead movements. By the second week, your surgeon may tell you it’s OK to begin light exercise or arm movements.

You can expect:

• Numbness in your reconstructed breast and belly, which may take up to a year to go away.
• Soreness and pain around your abdomen and chest, which should go away after about two weeks.
• Swelling around your reconstructed breast, underarm and belly for a few weeks.
• Tightness in the skin of your belly and around the reconstructed breast.

What is the outlook for people who have had DIEP flap surgery?

The success rates of DIEP flap surgery are between 96% and 99%. People with risk factors such as diabetes, high blood pressure and high cholesterol may have success rates on the lower end of this range.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Bleeding.
• Fever.
• Severe pain.
• Shortness of breath (dyspnea).
• Signs of infection in the incision sites, such as pus or foul-smelling drainage.

A note from Cleveland Clinic

DIEP flap surgery is a type of breast reconstruction. People may choose to have this procedure after breast cancer surgery such as a mastectomy or lumpectomy. A surgeon removes a flap of skin, fat and blood vessels from your lower belly during this procedure and transfers the flap to your chest. This is a muscle-sparing surgery, so you don't lose any muscle in your abdomen. DIEP reconstruction is more involved and requires a longer recovery than implant reconstruction, but it offers more natural-looking results.