Why Choose a DIEP

A deep inferior epigastric perforator procedure (DIEP) is a type of breast reconstruction that involves moving a section of tissue from the abdomen to the breasts. It is a highly advanced

surgery that transfers fat, skin, and blood vessels to recreate normal breasts after a mastectomy or lumpectomy.

With a DIEP flap procedure, women who have survived breast cancer can feel confidence in their bodies without the use of breast implants. It utilizes your own body’s tissue, doesn’t require further surgeries, and can produce natural-looking and feeling results.

As a board-certified specialist in aesthetic breast reconstruction and an accomplished resident teacher of plastic surgery, Dr. Michael A. Howard of Northwestern Medicine only uses the most innovative, updated techniques to create results that patients love for the rest of their lives. Call one of his offices in Lake Forest, Glenview, or Chicago, IL at (224) 271-4250 to get started with a consultation for your DIEP flap procedure.

Read Dr. Howard’s blog for more information about breast procedures.

The Anatomy of a DIEP Flap Breast Reconstruction

Undergoing breast reconstruction can be a healing experience for a woman who had previously fought breast cancer. A surgeon who performs DIEP flap breast reconstructions needs to have a deep understanding of the anatomy of the abdominal wall and the breasts. Within the abdomen lies a thick layer of fat that protects the abdominal muscles. The deep inferior epigastric arteries serve to oxygenate these abdominal muscles, and branch off into smaller arteries known as perforator arteries.

Blood that hasn’t yet been oxygenated is found within perforator veins. When it comes to a DIEP flap procedure, all of these structures are used to recreate the look of natural breast tissue by taking a section of abdominal tissue and moving it to the chest. The veins and arteries harvested are also used to ensure adequate blood flow and healing. Since the mid-90s, DIEP techniques have been proven to be safe, reliable, and an effective method of breast reconstruction that preserves the strength of the abdominal muscles. (1)

What Makes DIEP Flap Surgery Superior to MS-TRAM Flap Surgery?

A muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) surgery is similar to the DIEP flap surgery, except a small amount of abdominal muscle is also relocated to the chest. TRAM flap procedures have been shown to require longer hospital stays and have higher complication rates of hernias.

Benefits of DIEP Flap Breast Reconstruction

For many women looking to get a breast reconstruction, a DIEP flap procedure offers many benefits:

  • You won’t require additional surgeries, such as those needed to replace breast implants.
  • It utilizes your own body’s tissues, so it’s 100% natural.
  • Surgeons are able to check that blood circulation is adequate and working properly.
  • DIEP flaps can recreate the look and feel of natural breasts.
  • The abdominal muscles are better preserved than in TRAM flap procedures. (2)
  • Northwestern Medicine offers a comprehensive recovery plan to promote an easier and healthier recovery.
  • Nipples and aerolas can be sufficiently reconstructed after this surgery. (3)

Candidates for DIEP

Ideal candidates for the DIEP flap procedure include women who have had a breast cancer surgery who:

  • Are in good health
  • Are non-smokers
  • Have an adequate amount of belly fat
  • Haven’t had any previous abdominal surgeries
  • Have healthy-sized veins and arteries

For women who smoke, they should be willing to quit for a significant amount of time before undergoing the procedure. Finally, DIEP flap surgery is ideal for women who do not want to go through the surgeries and long-term maintenance of breast implants.

Personal Consultation

During a personal consultation, Dr. Howard will go over the necessary preparation you will need to do in order to get the best results possible. He’ll also review your medical history, medications, and discuss conducting blood tests to get an overview of your health. He can review your cosmetic goals, your outlook on the procedure, and what to expect from your results.

Preparation

Before your scheduled surgery date, Dr. Howard will give you specific dietary guidelines to follow and advise you to wear comfortable, loose, clothing on the day of your procedure. He will also review your medications and make revisions in order to optimize the results of your procedure and promote proper healing. In addition, you will also have to stop taking blood thinning medications and supplements at least two weeks before surgery; these can increase the chance of excessive bleeding during the procedure.

If you smoke or use nicotine products, you should plan on quitting at least six weeks before surgery so that your blood circulation and your healing process are not negatively affected.

DIEP Flap Breast Reconstruction Procedure

A DIEP procedure is split into two stages, and the entire procedure takes 6 to 8 hours. During the first part of the procedure, you will be given general anesthesia. If the patient is looking to restore both breasts after a mastectomy, an elliptical incision will be made in the abdominal area. When just restoring one breast, only half of an elliptical incision is used.

Dr. Howard will harvest a section of skin, fatty tissue, perforator veins and arteries from the abdomen. This section will make up one breast and is commonly referred to as the skin island. In the second stage, Dr. Howard will make an inframammary incision, an incision that follows the underside of each breast.

He will then locate the thoracic artery and thoracic vein near the sternum, within the chest wall. He revascularizes the skin island by connecting the perforator veins and arteries to the thoracic blood supply with precise microsurgery. By doing this, the skin island should begin bleeding slightly, indicating that it’s properly connected. He will then carefully form a breast and close the incisions to connect the tissue to the body. Once this is completed, the abdomen is then closed with a suture above the pubic line.

Recovery

During your recovery process, you will be prescribed medications to ensure that you remain comfortable as you heal. You will have to stay in the hospital for up to five days so that Dr. Howard and other medical professionals can monitor your progress.

Immediately after the surgery, you’ll be monitored at the post-anesthesia care unit (PACU) at Northwestern Medicine. Here, you’ll receive IV fluids and oxygen to ensure that you recover from the effects of general anesthesia. Patients can also expect to undergo an enhanced recovery program (ERP) to get back to your normal life as soon as possible. Research has shown that patients who follow enhanced recovery plans experience better cosmetic results and shorter hospital stays. (4)

Once you are home, you should rest for 6 to 8 weeks. During this time, you’ll have to wear a compression garment around your midsection and chest for several weeks to reduce swelling. After two weeks, you’ll be able to go back to work. If you have a physically strenuous job, you should consult Dr. Howard on when you should be able to return.

How Much is DIEP Flap Breast Reconstruction in Chicago?

A comprehensive personal consultation with Dr. Howard will ensure that you get all the information you need concerning the procedure, including the cost. Depending on your aesthetic needs, the surgery may require more or less time; those who need to reconstruct two breasts have to undergo a more complex surgery than women who only need one breast procedure.

With a phone call to Dr. Howard at (224) 271-4250 or a visit to his office in Lake Forest, Glenview, or Chicago, IL, you can get started on your journey to feeling more confident in your body today.

FAQ

How long is the recovery period for DIEP flap breast reconstruction?

After your procedure, you will need to stay in the hospital for five days. You should make a full recovery after 6 to 8 weeks.

Can DIEP flap surgery only for breast cancer survivors?

DIEP flap is a surgery that is only reserved for women who have had a mastectomy or lumpectomy as a result of breast cancer.

Can nipple reconstruction be performed during a DIEP flap procedure?

If needed, a separate nipple reconstruction can be performed. This is a basic procedure in which the surgeon makes an incision to create a nipple and tattoos a realistic-looking areola.

Can you receive radiation therapy after a DIEP flap surgery?

Any type of breast reconstruction should only be performed after you are done with cancer treatments. Radiation after receiving breast implants has been shown to increase the chances of scar tissue buildup around the implants- also called capsular contracture. After a DIEP flap procedure, radiation can shrink the breast tissue.

When will I see the final results of DIEP flap surgery?

After roughly 3 to 6 months, you will notice the final results. Since it is an extensive surgery, it takes a while for swelling to fully go down. In addition, you will notice your scars fading significantly.

References

  1. Xuan Hau Nguyen, Pham D, Hiền Nguyễn Xuân, et al. Deep Inferior Epigastric Perforator Flap for Immediate Breast Reconstruction following Mastectomy in Breast Cancer Patients: An Initial Experience in Vietnam. PubMed Central. 2023;2023:1-7. doi:https://doi.org/10.1155/2023/5964040
  2. Hyun Jun Cho, Hyo Jeong Kwon, Moon SH, Young Joon Jun, Jong Won Rhie, Deuk Young Oh. One-stage nipple and breast reconstruction using a deep inferior epigastric perforator flap after a skin-sparing mastectomy. Archives of Plastic Surgery. 2020;47(01):26-32. doi:https://doi.org/10.5999/aps.2019.00598
  3. Garvey PB, Buchel EW, Pockaj BA, et al. DIEP and Pedicled TRAM Flaps: A Comparison of Outcomes. Plastic and Reconstructive Surgery. 2006;117(6):1711-1719. doi:https://doi.org/10.1097/01.prs.0000210679.77449.7d
  4. Linder S, Walle L, Loucas M, Loucas R, Frerichs O, Fansa H. Enhanced Recovery after Surgery (ERAS) in DIEP-Flap Breast Reconstructions—A Comparison of Two Reconstructive Centers with and without ERAS-Protocol. Journal of Personalized Medicine. 2022;12(3):347. doi:https://doi.org/10.3390/jpm12030347
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