Breast Reconstruction (DIEP)
A DIEP (Deep Inferior Epigastric Perforator) flap is a type of breast reconstruction that uses a woman’s own abdominal tissue to create a breast post-mastectomy. Dr Bish Soliman will customise the procedure to your particular situation and goals in order to give you a final result suited to your needs and preferences.
Breast DIEP
What is a DIEP flap?
A DIEP flap refers to the process of removing a piece of skin, fat, and blood vessels from your lower abdominal region (below the belly button) and transplanting it to your chest area to create a breast using delicate microsurgery. The procedure does not interfere with the rectus (abdominal) muscle, and Dr Soliman takes the time to preserve the nerves that supply this muscle. This means that your abdominal strength is maintained.
Breast DIEP
Who is a good candidate?
Dr Soliman will discuss the suitability of a DIEP flap with you.
There are five things to consider:
- Current Health – If you are a smoker or have multiple medical problems then your risk of complications increases.
- Body Shape – You should have excess lower abdominal skin and fat to have a DIEP. If you carry your extra fat in other areas, then Dr Solimanwill discuss using other areas of your body such as your inner thighs or lower back for breast reconstruction. Dr Soliman is one of only a few plastic surgeons that offer these alternative reconstructions.
- Past Surgeries – Having prior abdominal surgeries is rarely a problem unless you’ve previously had an abdominoplasty.
- Treatment Needs – The timing of the DIEP may be related to other adjuvant treatmentsthat you may need such as chemotherapy or radiotherapy.
- Personal Preference – Every patient should understand all breast reconstruction options and make an informed decision. Some women who might be able to use their abdominal tissue may notchoose to do so. A DIEP is always an option later if you choose an implant reconstruction to begin with.
Breast DIEP
Your personal consultation
Before your procedure, get personalised guidance from highly skilled Specialist Plastic Surgeon, Dr Bish Soliman. With years of experience, he will aim to give you personalised treatment for your body, health, and ideal outcomes. Book your personal consultation to receive:
- In-depth information about your desired procedure
- Personalised advice from Dr Soliman
- A customised treatment plan tailored to your needs
Breast DIEP
The procedure
During a DIEP reconstruction, your surgeon will take skin and fat from a different area of the body. The most common sources of tissue are the back and the abdomen. The extracted skin and fat will then be transplanted to the chest and sculpted to form a new breast shape.
Breast reconstruction may also involve surgical reconstruction of the nipple. This can include adjustments to the nipple size or position. Additionally, some women may wish to combine their procedures with implants to enhance the volume and achieve the desired shape. The exact surgical techniques used during your reconstruction will depend on your specific circumstances and preferences.
For more information about the procedure and post operative course please download our information sheet.
Breast DIEP
Laparoscopic-assisted DIEP flap
Dr Bish Soliman presented a paper at the Royal Australasian College of Surgeons (RACS) 91st Annual Scientific Congress (ASC) at the Adelaide Convention Centre on the 3rd of May 2023. The paper was titled “First Experiences with Laparoscopic Assisted DIEP Flap Reconstruction in Australia”.
Breast DIEP
Aftercare
After surgery, your incisions will be bandaged, and you can expect to have some swelling, bruising, and tenderness. You may be prescribed pain medication to help manage any sensitivity after your breast DIEP.
Most patients will need to spend a couple of days in the hospital to be monitored during this beginning stage of recovery. Once you are home, it is important to take enough time to rest and continue your recovery. Personalised at-home care instructions will be prescribed to help you care for your body and encourage optimal healing. For example, you may be advised to avoid smoking and alcohol, minimise movement, and wear specialised compression garments. You may also need to have someone help you with daily tasks and chores around the house, including taking care of children.
Breast DIEP
Complications
Any invasive surgical procedure can have risks. DIEP flap risks include:
- Flap loss or failure – This rarely happens but it is a serious complication. The nursing staff and Dr Soliman will closely check on the new tissue of the reconstructed breast in the first few days after the operation. If there are any signs of a problem, you may need to go back to the operating theatre to have it checked. About 1 in 100 women who have a DIEP flap may need one of these ‘second checks’. Very rarely, the new tissue in the breast fails and an alternative method of reconstruction is needed.
- Haematoma – A haematoma is a collection of blood inside the body. The risk of this is 2%. If this develops, then you may need to be returned to the operating theatre for evacuation.
- Infection – Infection is rare. Antibiotics are given at the time of the surgery to reduce the chances of infection occurring.
- Seroma or build-up of fluid – This sometimes happens after the abdominal or breast drains have been removed, but it usually gets better within a few weeks. It occurs in approximately 1 in every 20 women. The fluid can be simply drained using a needle. If the seroma formation is a recurrent problem, then a rare injection of steroid needs to be applied. The seroma or its treatment does not usually have any long-term consequences.
- Lumps in the reconstructed breast (fat necrosis) – If the blood supply to some of the reconstructed fat is poor, this will form fat necrosis and will be replacedby scar tissue (lump). These lumps may or may not go away with time. Dr Soliman will advise you to massage these lumps and if they don’t resolve they may need to be surgically removed.
- Asymmetry – Most women’s breasts are asymmetrical. With advancing age, the breast also tends to ptose or extend. It is rarely possible to achieve perfect symmetry. Dr Solimanmay need to perform secondary minor surgery to help with this.
- Abdominal bulge or hernia – Weakness of the abdominal wall after a DIEP flap procedure may produce a bulge. Very rarely, damage to the muscle may produce a hernia that will require additional surgery for correction. This is an extremely rare complication because the abdominal muscle is left intact along with its nerves, which is the great advantage of the DIEP technique compared to the previously used TRAM flap breast reconstruction.
- Hypertrophic/keloidscaring – Some patients are predisposed to abnormal scarring. Dr Soliman’s aim is to minimise scarring by meticulously closing all wounds and by providing post-operative scar management advice.
Breast DIEP
Frequently Asked Questions
What is the difference between a TRAM and DIEP?
A TRAM flap involves removing a section of abdominal muscle along with fat and skin, while a DIEP flap preserves the abdominal muscle and reduces the post-operative risk of abdominal hernia and bulge.
To find out more, please read our published experience on this technique and this featured article.
If I have a breast implant, can this be converted to a DIEP flap?
Yes, as long as you have adequate abdominal tissue, an implant can be converted to a DIEP flap.
What is the benefit of a DIEP flap vs implant reconstruction?
Because a DIEP flap uses your own body’s tissue to reconstruct the breast, it will change in volume as your normal weight fluctuates through life and often tends to improve in shape over time. The breast is reconstructed with fat which “feels” similar to that of a normal breast.
An implant reconstruction tends to require multiple operations to achieve the final result and has associated risks including extrusion, capsular contracture, infection and leaking. Implant manufacturers don’t consider them “lifetime devices” so they will require replacement every 10 years or so. However, there is no one-size-fits all procedure, and you will need to speak to a qualified surgeon to find out which surgical method will work for you.
What effect will radiotherapy have on my implant and DIEP flap?
If a patient has had radiation or is planning to have radiation, implant reconstruction is discouraged because of the unacceptably high complication rate. A DIEP flap can be radiated with usually good outcomes. Dr Bish will discuss this further with you during your consultation.
What is a Laparoscopic DIEP?
The Laparosocpic DIEP flap is a new technique performed by Dr Bish and his colleagues. It allows minimally invasive dissection of the DIEP flap blood vessels with minimal disruption to the abdominal wall and its musculature. This technique minimises the chances of abdominal bulge or hernia and can lead to a comparatively shorter recovery time.
To find out more, please read our published experience on this technique and this featured article.
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