Breast reconstruction with abdominal flaps (DIEP)

DIEP (Deep Inferior Epigastric artery Perforator) flap is a flap vascularized by the inferior epigastric pedicle.

The technique consists in extracting abdominal skin and fat situated under the navel along with blood vessels feeding them.
These vessels are cut and reconnected on the intern mammary vessels through a microscope.
The DIEP flap implies a perfect control of the microsurgery.
The extraction of these tissues of the lower abdomen results in a horizontal scar above pubic hair. The flap skin corresponds to the skin of a plastic abdominoplasty.   Final scars are identical to the scars of this operation, which make this technique very popular.
The main benefit of DIEP flap is the absence of abdominal muscle impairment (which is not the case with TRAM): only the skin and the fat are extracted, like during a classic abdominoplasty.

DIEP flap is indicated:

• If the contralateral breast is too large.
• If belly anatomy is compatible (clear excess of abdominal skin under the navel).

The volume of the flap being important, no implant is necessary. It is a completely natural reconstruction without any foreign matter. The reconstructed breast if soft and voluminous and will evaluate a contralateral breast like the rest of the body, no implant being present.

Before the procedure

It is recommended to stop smoking one month before and one month after the surgery (smoking can delay healing). No aspirin-based medication should be taken during the 10 days preceding the operation.

The procedure

The operation is carried out under general anaesthesia. It lasts between 4 and 7 hours.
A preoperative abdominal angioscan is carried out to identify the perforator vessel with an adapted calibre.
A skin paddle situated under the umbilicus is extracted with its fat through a long horizontal incision above pubic hair.
The flap is extracted with its vessels, which are connected on intern mammary vessels and sometimes on the armpit vessels via microsurgery techniques.
The mastectomy scar is opened and the flap is placed and shaped. The belly skin is sutured.
Drains suck up post-operation secretions and reduce the risk for bruising.

After the procedure

Pain varies from one patient to another. It is systematically preventively treated and adapted to your case. Drains are removed between the 3rd and the 7th day. Hospitalization length is 7 to 10 days, which corresponds to the monitoring phase. It is recommended to wear a pressure garment for one month, day and night

Major risks of this procedure are the occlusion of the vessels connected by microsurgery during the first 10 days after surgery, which could lead to the complete failure of the reconstruction, or the occurrence of phlebitis.