Understanding options for breast reconstruction is an important step for breast cancer survivors.
To reconstruct a woman’s breast after a mastectomy, doctors have two main options: They can either use an implant or construct a new breast using tissue from the patient’s own body. For those who choose the latter, a procedure known as DIEP flap surgery offers long-term benefits other procedures do not.
What is DIEP flap surgery?
During the DIEP flap procedure, surgeons remove skin and fatty tissue from the patient’s lower belly and use it to reconstruct the new breast. The abdominal muscle is temporarily split while removing the deep inferior epigastric perforator (DIEP) artery. This artery – once reconnected in the chest – supplies the tissues with blood to keep it alive.
“The advantage of the DIEP flap is that we maintain the muscle that supports the lower belly, which is very important for a woman’s long-term function,” said Dr. Galen Perdikis, a plastic surgeon at the Vanderbilt-Ingram Cancer Center.
How DIEP flap is different
Other breast reconstruction procedures, such as the TRAM flap, remove a large portion of the abdominal muscle and reduce strength in the lower abdomen. Artificial mesh is often inserted permanently to cover the area where the muscle was removed.
“DIEP flap represents ‘a seismic shift in reconstructive options.’”
While TRAM flaps are still an option for many, DIEP flap represents “a seismic shift in reconstructive options,” Perdikis said.
Not only does leaving the abdominal muscle in place help prevent future hernias, bulging or other functional issues, there is also now the potential to reconnect nerves that could help preserve some sensation.
Benefits of DIEP flap procedures post-surgery
While DIEP flap is a complex surgery that involves both the chest and abdomen, very little follow-up is required once the initial sequence of surgeries is complete.
“Once you get through the reconstruction phase, you’re pretty much done with it for life,” Perdikis said, adding that people with breast implants face the possibility of ruptures or other complications and require regular follow-up throughout their lifetime.
“Once you get through the reconstruction phase, you’re pretty much done with it for life.”
DIEP flap is most commonly performed in a team-based academic medical center and requires specialized surgical training. It can be performed on both breasts simultaneously but cannot be repeated in future surgeries. Therefore, if a woman has one breast reconstructed using DIEP flap and later has her other breast removed, a different type of reconstruction would be required.
Patients with serious medical conditions, high body mass index or other health concerns may not qualify for the procedure and should discuss options with their doctors.
Personalized care for reconstruction
Vanderbilt Health surgeons can help you understand options for breast reconstruction, and tailor a care plan to meet your unique needs and health goals.