The Surgeon Minute

DIEP Flap: Reconstructing Breasts From Your Own Tissue

DIEP Flap: Reconstructing Breasts From Your Own Tissue

Being diagnosed with breast cancer is both terrifying and overwhelming. There are dozens of decisions to be made and, typically, they need to be made quickly. One of the more confusing, and critical, of these decisions is breast reconstruction. With all of the fear and stress involved with defeating breast cancer itself, having to worry about losing your breasts at the same time can be a lot. Fortunately, there are tremendous options to the modern women who needs her breasts reconstructed.

If you have to have a single or double mastectomy, there are two different ways to recreate your breast. You can use a breast implant and tissue expanders, which will enlarge a pocket of tissue on your chest that the implants will then occupy. The other option is to avoid implants all together and utilize your own tissue. Within this latter category, referred to as an autologous reconstruction, there are a number of choices, each taking tissue from different parts of the body. In the DIEP flap procedure, the plastic surgeon removes tissue from your abdomen and transplants it to your chest, creating a breast mound out of your own tissue and fat that will last your lifetime. Dr. Daniel Y. Maman of New York City discusses the many benefits of this very sophisticated, complex, and highly rewarding procedure. 

What is DIEP Flap?

DIEP stands for deep inferior epigastric perforators; “It’s a very complex, very specific surgery for breast reconstruction” explains Dr. Maman. It involves taking your own skin, fat and blood vessels from the lower abdomen (basically as a tummy tuck does) and transplanting this tissue up to the chest in order to recreate a breast. One of the main advantages of the DIEP flap versus other autologous reconstruction procedures is that, in most cases, no muscle needs to be cut or removed. This allows you to not only recover more quickly, but also reduces any risk of compromising your abdominal muscle strength.

Breast Implant vs. Tissue Based Reconstruction

For most women, the idea of losing one or both breasts is devastating, making breast reconstruction a vital realm of plastic surgery. It allows breast cancer survivors who have to undergo a mastectomy feel like themselves again. Many women who undergo breast reconstruction may have never been interested in plastic surgery, and therefore remain hesitant about implants and a procedure they may need to update in the future. For these women, a DIEP flap reconstruction may be the better choice. 

A breast implant reconstruction is fairly straight forward. Either at the same time of your mastectomy or at a latter date, tissue expanders will be placed under the skin of your chest in order to create enough space, over time, for the breast implant of your choice. Once the skin and tissues have been appropriately stretched, the expanders will be switched out for a breast implant. A tissue-based reconstruction, however, obviates the need for an implant by using your own living tissue. The advantages to using your own tissue include: 

  • no risk of your body rejecting the implant
  • looks and feels most like your breast
  • get a new breast & get rid of excess abdominal pooch 

Who is the Ideal Candidate for a DIEP Flap?

The best candidate for a DIEP flap procedure is relatively young and definitely healthy. This is a long operation and you must be able to withstand the recovery. You also need to have enough lower abdominal fat to create the right sized breast for your anatomy. Other ideal candidates are women:

  • who have had tissue expanders and implant based reconstructions in the past that have been unsuccessful
  • who’ve had implants that were too uncomfortable and/or painful
  • that developed complications with their implant based reconstructions due to radiation, chemotherapy or both
  • who have experienced a number of infections and just can’t tolerate having a foreign device in their body 

DIEP flap results - Maman.

The DIEP flap procedure is a long operation with a intensive upfront recovery. “But the lifetime benefit is unmatched,” says Dr. Maman. Breast cancer patients who have undergone a DIEP flap have a natural-looking and feeling breast for the rest of their lives without any of the potential complications that may occur with an implant such as:

The DIEP Flap Procedure

Dr. Maman has a dedicated DIEP flap team with whom he works, consisting of a group of two or three different surgeons. This is necessary due to the length and complexity of the surgery. First, the team will perform what is basically a tummy tuck. However, instead of disposing of the excess skin and fat, this lower abdominal tissue will be transferred up to your chest. Then, the surgeons will “mold it and cone it into the shape of a breast,” explains Dr. Maman. Next, using an operative microscope, he will utilize microsurgery to connect the very small blood vessels in your abdominal tissue to those in the chest. It is just like any organ transplant.

DIEP Flap Results 2 - Maman.

The DIEP flap procedure is one of those procedures with “incredible patient satisfaction,” says Dr. Maman. This is due in large part to how natural the new breast looks and feels. He has even had patients tell him how their gynecologist or primary care physician couldn’t tell that they’d had reconstruction. “We’re so refined in the way that we do it that we can hide the scars so that there are no perceivable scars on the breast.”

This is a state of the art procedure that not every practice offers. It requires “highly technical and specialized training and expertise and it is our privilege to offer this to our patients,” shares Dr. Maman. 

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