Diep Flap Surgery

What Is DIEP Flap Surgery?

Breast cancer strikes one in every eight American women. Those who survive are often scarred for life. If you’re one of those survivors, you don’t have to remain scarred. A DIEP flap surgery is a breast reconstruction technique that follows a mastectomy. DIEP stands for a deep inferior epigastric perforator type of flap surgery, and it’s a microsurgical technique to rebuild your breast.

During the procedure, a skilled DIEP flap surgeon uses the tissue, fat and blood vessels from your lower abdomen — the same fat that would be thrown away in a tummy tuck — to reconstruct one or both breasts lost to your cancer treatment. The procedure gets its name from the deep inferior epigastric perforator, the DIEP, which is the branch of blood vessels relocated during the procedure.

If your breast cancer surgeon recommends mastectomy, talk to a board certified cosmetic surgeon about DIEP flap reconstruction. The compassionate cosmetic breast surgeons at Rowe Plastic Surgery  in Manhattan, Long Island, New Jersey and the Hamptons perform transformative breast surgeries, including breast reconstruction.

They use a multi-disciplinary approach to breast reconstruction that includes:

• DIEP flap breast reconstruction
• Breast augmentation
• Nipple reconstruction and correction

What Are the Types of DIEP Flap Breast Reconstruction?

The DIEP flap procedure differs from other breast reconstruction surgeries because the surgeon leaves your abdomen muscles in place. The DIEP flap breast reconstruction is an improvement over other surgical procedures, such as the TRAM breast reconstruction, and offers unique long-term benefits. The timing of a DIEP flap breast reconstruction can differ, so there are three types of the procedure:

1. Immediate DIEP flap reconstruction. This procedure includes two separate surgeries. The first is the mastectomy, in which your breast cancer surgeon removes your breast tissue to treat or prevent breast cancer. Next, your plastic surgeon starts the breast reconstruction while you’re still under general anesthesia.
2. Delayed DIEP flap reconstruction. If you need further cancer treatment, including radiation therapy after your mastectomy, you can’t have an immediate DIEP flap breast reconstruction. The delayed DIEP flap surgery takes place later, after you’re through with your cancer treatments. The delayed procedure reduces DIEP flap surgery risks, involves intense testing to be sure you’re cancer-free and has specific advantages.
3. Two-staged DIEP flap surgery. In this delayed DIEP flap surgery, your cosmetic surgeon inserts a tissue expander into your breast skin and muscle at the time of your mastectomy. During this stage of a delayed DIEP flap surgery, the silicone tissue expander maintains the shape of the removed breast. The second-stage DIEP flap surgery comes later, after your radiation therapy or chemotherapy have completed.

At one of the Rowe Plastic Surgery facilities in New Jersey and New York, the surgical team carries out extensive tests to determine the best surgery plan for your case. After your mastectomy, several factors determine the best time for your DIEP flap breast reconstruction.

What Happens During a DIEP Flap Surgery?

A DIEP flap breast reconstruction is a major cosmetic procedure performed by a top DIEP flap surgeon while you’re under general anesthesia. It takes between six and eight hours, depending on if one or both breasts need reconstruction. The steps in this breast procedure include:

1. Consultation. Once you’ve picked a top cosmetic surgeon, schedule an initial consultation. The surgeon evaluates your medical history, examines you and listens to your expectations. The best DIEP flap surgeons may offer multiple options for breast reconstruction besides DIEP flap surgery.
2. Preparation. Your surgeon develops a personalized treatment plan with the most appropriate procedure for you. Before the surgery, your doctor gives you instructions to stop some medications and quit smoking weeks before surgery.
3. Mastectomy. For an immediate or staged DIEP flap surgery, your breast cancer surgeon removes the breast tissue of one or both breasts.
4. DIEP flap surgery. In an immediate DIEP flap procedure, your plastic surgeon makes an incision across your lower abdomen. The surgeon removes a flap of skin which includes fat and blood vessels, but leaves your abdominal muscles intact. Then your plastic surgeon attaches the transplanted tissue to your chest’s blood supply. In a delayed procedure, this step happens later. In a two-staged procedure, a tissue expander is inserted, and stage two happens later.
5. Breast reconstruction. Using the DIEP flap, your plastic surgeon recreates a breast mound on your chest. For a single mastectomy, the surgeon matches the new breast to the remaining one. The procedure also involves connecting the flap’s blood vessels to your chest’s blood supply.
6. Closing. After the breast reconstruction is set, the surgeon stitches the incisions in your abdomen and on the new breast.

If you have breast cancer and your surgeon recommends a mastectomy, consider DIEP flap breast reconstruction as part of your recovery. For a delayed DIEP surgery, your plastic surgeon inserts tissue expanders in your chest and then waits for the second stage of the DIEP flap surgery to complete rebuilding your breast. This usually doesn’t happen until you’ve completed all your cancer treatments.

How’s the Recovery from the DIEP Flap Procedure?

Your recovery from DIEP flap breast reconstruction varies. Some helpful notes about mastectomy DIEP flap recovery include:

• Expect pain, swelling, and soreness on your lower abdomen and breasts immediately after the surgery and for several days.
• Your cosmetic surgeon may fix drains in the breast site and abdominal area to keep excess fluids away from the incisions to aid healing.
• You may need a compression girdle for up to eight weeks after surgery to promote healing.
• Expect difficulties when standing or sitting because of the abdominal incisions.
• Avoid strenuous activities that can slow down healing.
• Expect DIEP flap and abdomen scars, which fade over the next few months.
• Within four to six weeks after surgery, you can start to drive again.
• Avoid heavy lifting and sexual activities for about six months.
• The full results of your breast reconstruction usually take several months to appear.

For most women, DIEP flap surgery recovery takes between six and eight weeks. If you need a delayed DIEP surgery, the second part comes after your final cancer treatments. A second surgery rebuilds your breast.

Diep Flap Surgeons in New York and New Jersey

Here at RPS, we work together as three expert surgeons, in addition to our large staff of nurses, physician assistants, and other team members.

Dr. Lisa F. Schneider
Plastic & Reconstructive Surgeon

Dr. Norman M. Rowe
Plastic Surgeon

Dr. Charles Pierce
Plastic Surgeon

What are the benefits of the team approach?

Your care will be holistic and guided by experienced hands. Every interaction, including each phone call and email, will be with one of our staff members trained to help you through this difficult time. You will have a community working together for you, rather than one physician working alone or a hospital whose care can often be impersonal.

DIEP Flap Reconstruction FAQs

• Is it possible to regain sensation in my breast or even in my nipple after a mastectomy? Yes! When you undergo DIEP flap surgery, a top surgeon connects the nerve in the flap to the nerve in your chest. Sometimes, this does result in a breast or nipple that has sensation.
  
• What are the benefits of a DIEP flap surgery? You get more natural-looking results. The reconstructed breast is more like your original breast than an implant-reconstructed breast. The new breast is made of warm, soft, living tissue from your tummy.
• Is a DIEP flap the same as a tummy tuck? The focus of the DIEP flap surgery is natural breast reconstruction, but it may give you the benefits of a tummy tuck, including toning and tightening.
• What’s the difference between a DIEP flap and a TRAM flap? A TRAM (transverse abdominis muscle) flap involves taking the fat and muscle from your abdomen to construct a new breast. A DIEP flap involves taking the fat, but leaving the muscle. A DIEP flap is a more technically difficult operation, as your expert surgeon carefully separates the blood vessels from the muscles of your abdomen to preserve them.
• What’s better: DIEP flap or implants? Studies on DIEP flap vs. implants show higher satisfaction levels with DIEP flap surgery. There are higher DIEP flap surgery risks, but the results last a lifetime, while an implant’s lifespan is 10 to 20 years.
• If I already have breast reconstruction with implants, can I still get a DIEP flap? Yes. If you had breast implants for your reconstruction or no reconstruction at all, you’re a candidate for DIEP flaps.
• Is it possible to get a DIEP flap procedure years after a mastectomy? You can have a DIEP flap years after your initial cancer surgery, especially if you’ve undergone radiation and you prefer a softer, more natural-looking breast. Patients who undergo a delayed reconstruction often have high satisfaction rates with their procedures. A DIEP flap can be performed at the time of your mastectomy or at any time afterward.
  
• Do DIEP flap surgeries fail? Rarely. The signs of DIEP flap failure become obvious. The tricky part of the procedure is connecting the tissue from your abdomen to the blood supply in your chest. If done improperly, the DIEP flap fails, and the tissue dies. To avoid this, choose an expert in the procedure.
• I have lymphedema; can it be addressed at the same time as my breast reconstruction? You can combine a DIEP flap surgery with a lymph node axillary or armpit reconstruction if you have lymphedema.
  
• Is DIEP flap surgery covered by insurance? Insurance policies that cover a mastectomy also pay for a breast reconstruction of your choice, including DIEP flap surgery.

If you need a mastectomy, consider the benefits of breast reconstruction to regain your figure and your femininity. The plastic surgery team at Rowe Plastic Surgery uses their expertise to carry out successful breast surgery procedures. Contact the NYC practice today to schedule a consultation. Do it before you schedule your mastectomy. Find their offices in Manhattan, Planview and Water Mill, NY and in Montclair and Red Bank, NJ.

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If you’re ready to schedule your breast lift or simply want to learn more about the procedure, our doctors can give you the answers and reassurance you need to make the decision that’s right for you. To schedule your private consultation, call 212-628-7300.

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