DIEP Flap Surgery: Tissue Based Breast Reconstruction

Today, there are two types of procedures women can choose from implant-based reconstruction or soft tissue-based reconstruction. Implant-based breast reconstruction is the most common and is often the most convenient when it comes to recovery and downtime. However, soft tissue reconstruction, like DIEP flap surgery, is a great alternative. 

There are many advantages to this technique, but the procedure and recovery time is much longer than it is with breast implants. Continue reading to see if DIEP flap surgery might be a good fit for you!

What is DIEP Flap?

DIEP (Deep Inferior Epigastric artery Perforator) flap surgery is an autologous surgery. What does that mean? Tissue from other parts of the body is used to complete the reconstruction. Specifically for this reconstruction, a portion of skin, fat, and blood vessels is taken from the lower abdomen to recreate the breast.

How Is DIEP Flap Reconstruction Surgery Done and What is Used?

DIEP flap surgery typically takes about 6-8 hours. An incision is made in the lower abdomen, from which the surgeon will remove the portion of skin, fatty tissue, and blood vessels. The abdominal incision is closed by pulling down the abdominal skin, and then the belly button is repositioned to naturally fit the improved contour.
The skin, fatty tissue, and blood vessels are moved to the chest, and the blood vessels in the flap are connected to those found within the chest to allow the flap to remain a healthy and functioning new part of the breast. This procedure can be used to reconstruct one or both breasts.

The Advantages of DIEP Flap

DIEP flap surgery has several advantages compared to an implant-based reconstruction. The results of DIEP flap surgery have a more natural look and feel. “The tissue continues to grow and age with you”. Additionally, the patient gets a free “tummy tuck” out of the procedure.

TRAM Flap Reconstruction Surgery

Another popular tissue-based reconstruction is the TRAM flap reconstruction. However, DIEP surgery comes with fewer risks. During a TRAM reconstruction, abdominal muscles, skin, fat, and blood vessels are removed from the abdomen to reconstruct the breast. By preserving the abdominal muscles in a DIEP surgery, patients have less postoperative pain, less post-surgical abdominal wall weakness, and a decreased risk of hernia formation.

What to Expect After Surgery

Because DIEP flap surgery involves two sites on your body, the time it will take for your body to fully recover will be longer. However, it is super important to allow the time your body needs to heal. You will have surgical drains that will remain for one to two weeks after surgery depending on whether one or two breasts are reconstructed.

You will have to avoid heavy lifting, strenuous exercise, and sexual activity during your recovery period. Additionally, your doctor will advise you to start stretching exercises after you have reached a certain point in your recovery period.

How Long is the Recovery Period from DIEP Flap surgery?

DIEP flap surgery is not for everyone. After the procedure, you will usually stay in the hospital for about three to five days and the recovery period can take up to eight weeks. That’s roughly double the recovery time of implant-based reconstruction.

How Will I Feel After DIEP Flap Reconstruction?

Immediately after your surgery, you will feel sore around your breast and around your abdomen. For the next few weeks, you can expect pain and soreness that will improve as you advance through recovery.

How Will My Breast(s) Feel After Surgery?

After you’ve recovered from your surgery, your breast will regain some of its natural sensations over time. This happens because your plastic surgeon uses your body’s skin cells, fat cells, blood vessels, and nerves to reconstruct the breast. As you continue to heal, the nerves can start connecting again, which will restore sensation.

Just be aware, that normal sensation won’t completely return, but as your breast continues to heal, some feeling will usually return.

Can My Nipples Be Reconstructed?

When you undergo a mastectomy to remove breast cancer, you may receive either a nipple-sparing mastectomy or a non-nipple-sparing mastectomy. Essentially, during nipple-sparing breast cancer removal, your surgeon will make incisions around the nipple in order to keep the rebuilt breast mound as natural-looking as possible.

However, you might not be able to have nipple sparing surgery. But, once your breasts heal from the initial DIEP flap procedure, a plastic surgeon can either reconstruct your nipples with more of your natural tissues and a tattoo to create an areola.

How Long Until I Can Exercise After Surgery?

As stated earlier, you should avoid strenuous exercise after your surgery. After about two or three days, you will need to start doing some arm exercises to help your muscles function and heal properly. You can do some isolated exercises to help prevent blood clots.

The general window of time before you can exercise again is about 5 to 6 weeks. However, everyone’s recovery process will look different, so you should always consult your doctor before engaging in any vigorous exercise.

You should also not lift anything above your head during your recovery period, as it could damage the rebuilt breast and cause complications.

Risks of DIEP Flap Surgery

Fat Necrosis

This condition occurs when the transferred tissues do not receive a sufficient blood supply to oxygenate the cells. As a result, the fat tissues without enough blood harden and die, causing lumps in the reconstructed breast. Symptoms also include discoloration at the reconstruction site, the breast becoming cold to the touch, fever, and the development of open wounds in the later stages of necrosis.

Your plastic surgeon can remove the necrotic tissue with further surgery while maintaining the shape of the breast.

Abdominal Hernia

Because DIEP flap surgery takes tissue away from your abdomen, there is a small risk for developing an abdominal hernia. Most hernias, in fact, occur in the abdomen. To reduce the risk of developing a hernia, you should rest well and avoid lifting heavy objects or straining your abdominal muscles.

Thankfully, the risk of a hernia is much lower if you undergo DIEP flap surgery. Especially when compared to the risks associated with TRAM flap procedures that take fat and muscle from the donor site.

Abdominal Weakness

As your body heals from the procedure, you will most likely experience abdominal weakness, soreness, or pain. But that weakness will get better over time and once you return to your full activity level.

Blood Clots

One of the serious risks associated with DIEP flap surgery is blood clots and pulmonary embolism. Your risk for blood clots may be higher depending on your health history, especially if you smoke regularly.

While preparing for surgery, your doctor may give you blood thinners or other preventative medications before your surgery.

Infection

Any type of wound to the body is at risk for infection. Even with the highest levels of sanitation, infection can still occur around either the reconstruction site or the donor site. Fever, fluid build up, pain, swelling, and redness are all signs of a possible infection.

Fluid Build-Up

Medically referred to as seroma, buildup of plasma fluid around the surgery sites that results in a small, swollen lump. Patients often develop seromas after DIEP flap surgery, which is why surgical drains are placed in the reconstructed breast to give the plasma an outlet. But, even with drains, the plasma can collect under the incision site and create seromas.

Typically, a seroma is harmless, but they can develop infection. An infected seroma should be drained, or removed before the infection spreads and damages other tissue.

Flap Failure

If tissue necrosis occurs throughout the entire breast flap, the flap has reached total failure. When this happens the entire must be removed through surgery. If the dead flap tissue is removed in time, your surgeon might be able to use that tissue. However, once the flap is removed, it will have to be replaced.

Dog Ear Scars

These form on the ends of the abdominal scar after DIEP flap surgery. Dog ears are harmless deposits of skin and fat that fold or droop over the incision scar. Usually, dog ears will go away on their own. But if you don’t see signs of improvement, you can massage the scar until it goes away.

If they don’t go away on their own, your plastic surgeon can perform a revision surgery to get rid of the dog ears.

DIEP Flap Surgery in Nashville, TN

Dr. Robert Garza has a dedicated focus on DIEP flap surgery (tissue based breast reconstruction). Visit Garza Plastic Surgery today in Nashville, TN to discuss whether or not DIEP flap surgery is a good fit for you. If not, we can offer a variety of alternatives and answer any questions you may have to help find the best solution for your goals and medical needs. Call us today at (615) 620-7800.