Diep Flap Surgery (Breast Reconstruction)

You will receive a general anaesthetic which means that you will not be awake or feel any pain throughout the procedure.

Your surgeon makes a long cut (incision) in your stomach area (abdomen), from one hip bone to the other, below your tummy button. A flap of skin with fat and blood vessels is removed. Your surgeon doesn’t remove any muscle. Excess abdominal skin and fat in this area is often discarded if not need to match the required breast volume. 

Your surgeon then makes another cut in your chest (usually using the same incision line from your mastectomy) and moves the flap to your breast site. The blood vessels from the flap are then reattached to the blood vessels in your chest. Your abdominal skin and fat are used to recreate the breast mound and shape.

You may have drainage tubes inserted in the incisions to remove excess fluid, reduce swelling and reduce the risk of infection. They will be removed a few days later after surgery.

Your breast is shaped to either match your unaffected breast, or alternatively shaped into a smaller more uplifted breast should a breast reduction be one of the patients’ goals. The unaffected breast can be lifted and reduced to match the new reconstructed breast.

Your abdominal incision is sutured closed creating a tighter and flatter stomach. A separate scar is created around your belly button to relocate it back to its original position.

You will need to stay in hospital for three to four days after the procedure. During this time, your healthcare team will closely monitor your progress. You’ll have regular checks to ensure that the blood flow to the transplanted tissue is sufficient. Before being discharged, your healthcare team will give you detailed instructions about:

• taking care of your incision at home.
• How to contact your MPH team should you have any issues 
• what medicines to take or not to take.
• which type of clothes to wear including supports bras and abdominal compression 
• when and how to return to normal activities.

You are advised to rest completely for the first ten days when you go home. Patients generally return to normal life within 6 to 12 weeks, with swelling and bruising lasting for up to 8 weeks. Patients are normally able to drive again after 2-4 weeks. 

Any type of surgery has risks, and the failure rate of DIEP flap procedures is extremely low at less than 1%. The risks associated include:

• General risks associated with anaesthesia
• Bleeding
• Fluid collection in the surgical area (called a seroma)
• Problems healing
• Bruising and swelling
• Infection
• Blood clots – usually occur in the first 48 hours and while under observation
• Excessive scar tissue
• Loss of sensation
• Total flap loss (complete failure) if the blood vessels clot or fail (<1%)
• Partial flap loss where small areas of tissue may not get enough blood and harden (5-15%). This sometimes self-resolves; but occasionally needs minor revision surgery.
• Hernia (<1%)

There are a number of factors to that are taken into account when considering the best reconstruction option for you. These include :

• whether your chest tissue has been affected by radiation therapy, prior surgeries or aging, as this may affect your outcome after reconstructive surgery. In general, radiation therapy does not allow for implant based reconstruction. In these cases, a DIEP flap is ideal.
• your health status and health history. Patients who smoke, are overweight or have diabetes may have increased risk of complications and may not be suitable.
• whether you’ve already had DIEP flap surgery to reconstruct your other breast. Blood vessels, fat and skin can only be taken from your abdomen once.
• whether you don’t have enough extra fat and tissue in your abdomen. In this case, PAP flap surgery may be an alternative.
• any condition you have that may cause blood flow problems, such as diabetes, or vascular disease. The tissue used in the procedure needs good blood flow to survive. 
• whether you have had other abdominal surgery such as abdominal wall reconstruction or a colostomy. 
• whether you are having a bilateral mastectomy (with both breasts needing reconstruction).

Your surgeon will discuss the above with you.

A plastic surgeon with specialised training in microvascular tissue transfer performs DIEP flap surgery. Microvascular tissue transfer is a complex technique to transfer blood vessels from one part of your body and reattach them in another part of your body.

DIEP flap surgery typically takes between three and four hours for one breast, depending on whether you’re having immediate or delayed reconstruction. 

Patients typically have two areas of scarring: a long horizontal scar across your lower abdomen and another around the cancer site (usually along previous mastectomy incision). A circular scar is also required around the belly button. The flap scar is generally quite low, and is hidden under your under-clothes or swimsuit. While the scars can seem extensive initially, they generally soften and fade over time and there are a number of things you can do to improve them.